With the opening of the 115th Congress, the easy campaign talk of “repeal and replace Obamacare” has become the challenging policy and procedural aspects of actually getting it done. Few would argue that, at a minimum, the Affordable Care Act needs a major overhaul. What counts as politically acceptable “repeal” will be fought out on the nation's op-ed pages, radio call-in shows, and among Republican and Democratic members on the various cable channel talk programs.
A few markers probably have to stay in place. The provisions to allow children up to 26 years old to remain on their parents' policy and the requirement to offer insurance notwithstanding pre-existing conditions probably top that list. But, the basis of the accounting (which probably made Bernie Madoff jealous) was that, like any insurance pool, a lot more people have to pay in and use little or none of it, to offset those who pay little and use a great deal.
