Repealing Obamacare has been the rallying cry of the Republican Party ever since the law passed. When they finally got their chance this year, however, it quickly became clear that while tearing the law down might sound good, uniting behind a replacement was a much tougher task.
And so, “repeal and delay” was born. Top Republicans proposed that they would repeal the law immediately (and score a quick political win in the process), but wait to actually enact that repeal for a few years, during which time they would cobble together a workable replacement. The plan was widely derided by medical professionals, health care policy experts, the public, many members of Congress, and President Donald Trump — and was ultimately shelved.
Now, with the GOP’s health care plan floundering in the Senate, it’s back.
In an open letter addressed to President Trump on Friday, Sen. Ben Sasse (R-NE) asked the president to call on Congress to repeal Obamacare now, and then spend August working on a replacement.
“If we don’t get to agreement on a combined, comprehensive ObamaCare repeal and replace plan by [July 10th], I humbly suggest that you publicly call on the Congress to do two things: (1) to immediately repeal as much of ObamaCare as is possible under Congressional budget reconciliation rules, and then (2) to cancel the scheduled August state work period and instead to spend that month working through regular order, six days per week, writing a health reform package with a vote to be scheduled on Labor day,” Sasse wrote.
Pushing the idea on Fox & Friends, Sasse proposed repealing “the maximum amount of Obamacare that we can” immediately, but delaying the effect for a year, during which they’d craft a replacement.
Trump himself chimed in on Twitter, supporting repeal and delay.
If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!
— Donald J. Trump (@realDonaldTrump) June 30, 2017
This despite the fact that Trump himself was one of the detractors of this strategy only a few months ago.
“[W]e’re going to do it simultaneously. It’ll be just fine,” Trump said in a 60 minutes interview in November. “We’re not going to have, like, a two-day period and we’re not going to have a two-year period where there’s nothing. It will be repealed and replaced.”
And on January 11th, he reiterated his commitment to simultaneous repeal and replace: “It will essentially be simultaneously,” he told reporters at his first press conference since the election.
Trump was far from the only politician to go on the record opposing repeal and delay.
“I don’t think we can just repeal Obamacare and say we’re going to get the answer two years from now,” Sen. Tom Cotton (R-AK) said in January. “Health care is a very complex issue. We haven’t coalesced around a solution for six years, in part because it is so complicated. Kicking the can down the road for a year or two years is not going to make it any easier to solve.”
Sen. Rand Paul (R-KY) was also a staunch opponent, telling reporters “you can’t wait six months or a year and leave people floundering about without an alternative.”
I just spoke to @realDonaldTrump and he fully supports my plan to replace Obamacare the same day we repeal it. The time to act is now.
— Senator Rand Paul (@RandPaul) January 7, 2017
Other critics included multiple GOP governors, Sen. Susan Collins (R-ME), Sen. Lamar Alexander (R-TN) and Sen. Bob Corker (R-TN).
“There’s more and more concerns about not doing it simultaneously,” Corker said when the plan was floated in January. “You would think after six years we would have a pretty good sense of what we would like to do.”
Each of those Republican detractors matter, because their strong statements would make it hard for them to flip-flop on the issue without losing major political points for hypocrisy. Republicans can afford to lose only two Senate votes on any bid to repeal Obamacare, even when using the budget reconciliation process to bypass Democratic votes.
Senate rules also pose another problem: Senators can use budget reconciliation to dismantle Obamacare now with 50 votes, but to pass a new bill they’re going to need to go through the normal rules process. That means they’ll need 60 votes — which is impossible without Democratic support, and thus extremely unlikely.
Beyond the political implications, however, repeal and delay is fundamentally reckless. Repealing Obamacare immediately would set up a rapidly-approaching cliff, and Sasse and Trump’s calls are essentially gambles that Congress can come together and find a replacement before the American health care system falls off it.
Sasse’s call for Republicans to come together in August over a health care replacement plan is also ludicrous given their record so far. As Corker noted, Republicans have had six years to coalesce around an alternative plan, and have thus far failed. They’ve also now been actively trying to come up with and pass a better solution for half a year, and have thus far failed.
So to suggest that they can, in two months, come up with a plan to something as complex as health care while up against a potentially catastrophic deadline is to make a huge gamble with millions of Americans’ access to health care.
More likely, the end result of such a gambit would be an immediate repeal, with no replacement forthcoming. Lawmakers could either let the system implode, or keep extending the deadline, as they did for years when they couldn’t agree on a federal budget.
That too, however, would have a disastrous effect on American health care.
Insurers depend on projections to set price levels — if they are told that the federal regulations governing their entire industry are going to change but not how (or maybe not even when), the inevitable result is widespread uncertainty. That uncertainty will most likely cause insurers to pull out — and for Americans to be left with less competition and even higher premiums. In essence, it’s likely to set off a death spiral and cause Americans to lose their insurance.
When Republicans floated a similar idea in 2015, the nonpartisan Congressional Budget Office estimated that it would result in 32 million Americans losing their insurance, and health care premiums doubling by 2026.
Ultimately, repeal and delay failed the first time because it’s a bad and dangerous idea — as conservative think tanks, major medical lobbying groups, doctors, and Republican governors whose states benefited from Obamacare all pointed out.
President Trump, however, is nearing the end of his sixth month in office without any major legislative accomplishments — and is calling for a political win at any cost.