The Republican plan to repeal Obamacare and delay the implementation of the repeal — with a promise to come up with a terrific replacement later — is probably the party’s best way to destroy Obamacare. Unfortunately for Republicans, it’s also the best way to destroy the Republican majority in Congress.
Something big is happening in the Senate right now: The Republican plan, affirmed again today by Senate Majority Leader Mitch McConnell, is facing dire peril from Republican defections. Republicans need a House majority, 50 Senate votes, and soon-to-be President Trump to pass repeal and delay.
If Republicans lose three Senate votes, that drops them to 49, and repeal and delay cannot pass. At least three Republican senators (in addition to all the Democrats) now oppose repeal and delay. Rand Paul, of all people, has demanded that Congress repeal Obamacare at the same time it passes a plan to replace it. Paul has announced that he spoke with Trump and secured his agreement on this. Trump has not said so himself, confining his comments to date to a vague assurance, “That’s all gonna work out.”
Trump, of course, tends to change his mind frequently and agree with whomever he spoke with last. But other Republicans senators are taking the initiative. Fellow Republican Lamar Alexander says the same thing as Paul: “We have to take each part of it and consider what it would take to create a new and better alternative and then begin to create that alternative and once it’s available to the American people, then we can finally repeal Obamacare.” Senator Tom Cotton of Arkansas said on MSNBC, “It would not be the right path for us to repeal Obamacare without laying out a path forward.” And Senator Bob Corker is walking right up to the edge of the same position, asking Trump to tweet out confirmation of what Paul claims he promised. “If it is his view, it would be really good if he would consider tweeting it out very clearly. There’s more and more concerns about not doing it simultaneously,” Corker says.
Even more ominously for the Republican leadership, four other Republicans have joined Corker to sponsor a bill delaying the bill that would repeal Obamacare for a month:
Portman, Collins, Cassidy, and Murkowski have not joined the other three in formally opposing any bill that repeals Obamacare without a replacement. But their willingness to buck their party leadership and try to delay a vote that McConnell hopes to rush through as quickly as possible indicates severe reservations about repeal and delay. Meanwhile, numerous Republican governors — who don’t have a vote on it but can nonetheless exert pressure — are lobbying Washington Republicans to protect the parts of the law that their states rely on.
The stated goal of the dissenters is mild: They merely want to take a little more time to clarify what comes next. “You would think after six years we would have a pretty good sense of what we would like to do,” explains Corker. Of course, they don’t have a good sense of what to do. They have some vague concepts without agreement. And any Republican plan, when fleshed out, turns out to be extremely risky. Conservatives hate Obamacare because it redistributes too much money from the rich and healthy to the poor and sick. But they don’t publicly attack the law on that basis. Instead they attack it for high premiums, high deductibles, and narrow choice of doctors and hospitals — all flaws that any Republican plan would have in much higher doses. Republicans have yet to unify around a single, concrete, scorable plan because it is conceptually impossible to design a health-care plan that meets conservative ideological goals and is also acceptable to the broader public.
In other words, the dissenters pretend they just want to give the GOP a little more time to design its plan. But more time isn’t going to help. There’s never going to be a Republican plan. Republican leaders like McConnell promise the replacement will come soon thereafter, but people in the insurance and medical industry aren’t idiots. They know later means never.
Senate mechanics also explain why it’s so significant to demand that Obamacare be replaced at the same time it’s repealed. Republicans can use a budget reconciliation bill to defund Obamacare. A reconciliation bill can evade a filibuster and pass with just 50 senators. But that bill can’t create a new system, because reconciliation bills can only be used to change taxes and spending. The insurance regulations — requiring insurers to cover essential benefits, not discriminate against people with preexisting conditions, and so on — aren’t taxes and spending. They can only be altered with a regular bill, subject to a filibuster. That means if Republicans want to actually put a new system into place, and not just turn the health-care market into a smoking crater, they need at least eight Senate Democrats to join them.
What that means is that replacing Obamacare at the same time it’s repealed would create completely different parameters for what happens next. There aren’t going to be eight Democrats willing to support a right-wing bill that throws people into catastrophic coverage plans that don’t cover basic medical care, as conservatives would like. It would be a coalition to patch up Obamacare with incremental changes. Maybe Republicans would call it “repeal” of Obamacare and “replacement” with something that’s about 90 percent similar, but that would be symbolic. A bipartisan law would advance Obamacare’s goals rather than destroy them.
That’s why repeal and delay was the best chance to destroy Obamacare. The gamble was that, by blowing up the health-care system on a fuse, Republicans could pressure Senate Democrats into going along with a Republican-friendly replacement. The details might be unpopular, but coerced Democratic support might give it cover. But this plan only works if 50 Senate Republicans are willing to gamble that they can hold the one-seventh of the economy consumed by health care hostage and force a bunch of Democrats to go along. If that gamble fails, the ruin could easily trigger a backlash against the majority party. Apparently not enough Senate Republicans are willing to roll the dice. If this holds, Obamacare, or something substantially similar, is probably going to survive.