Republicans in Congress are preparing to immediately move on repealing Obamacare, one of President-elect Donald Trump’s central promises. Some GOP lawmakers have suggested the repeal vote may be scheduled next month, before Trump’s inauguration on January 20.
But Republicans are becoming aware that, while rallying to vote against Obamacare will be easy, what comes after that will be much harder.
For years, Republicans have been voting to repeal President Obama’s signature piece of health care reform. But as long as Obama has been in the White House to veto these attempts, the repeal effort has amounted to little more than political theater — a way for conservative lawmakers to win points with their base by proving how much they’re opposed to Obamacare. Voting to scrap health care reform didn’t lead to any real-world consequences (other than wasting Congress’ time and money).
With Trump as president, however, repealing Obamacare is no longer simply an empty threat. Republican lawmakers can actually make it happen. Then, they’ll be responsible for figuring out how to unwind the maze of laws and regulations that have become entrenched in our nation’s complicated insurance industry over the past several years — and that have resulted in 20 million additional Americans gaining health coverage.
It’s a daunting prospect for a party that has struggled to unite around any concrete health care ideas outside of a shared opposition to Obamacare.
For one thing, Republicans don’t have a replacement plan ready. Despite fighting against the Affordable Care Act for the past six years, GOP lawmakers have yet to offer any meaningful health policy alternatives.
For another, plenty of these Republican lawmakers’ constituents are benefiting from Obamacare’s provisions and aren’t eager to lose them. In fact, now that repealing the health care reform law is becoming a more concrete reality, Americans are less enthused about it. According to polling from the Kaiser Family Foundation, which has been surveying public opinion about Obamacare for years, the portion of Republicans who say they want the entire law to be repealed has dropped from 69 percent before the election to 52 percent in the aftermath of Donald Trump’s victory. Altogether, three-fourths of Americans do not support Obamacare repeal.
The cold, hard realities of repeal are especially hitting home for Republicans from states that opted to expand Medicaid, a provision of the health law that extends coverage to additional low-income Americans. Medicaid expansion has been particularly successful in Trump strongholds like Kentucky and West Virginia, where residents are more likely to be poor and sick.
“I’m from a state that has an expanded Medicaid population that I am very concerned about,” Sen. Shelley Moore Capito (R-WV) told TPM this past week. “I don’t want to throw them off into the cold, and I don’t think that’s a strategy that I want to see. It’s too many people.”
Since there’s no replacement plan to substitute in for Obamacare, and since it’s not politically viable to simply take away health coverage from millions of people without a replacement, some party leaders are putting forth a third option. They say that after formally repealing Obamacare next month, they’ll delay the implementation of that repeal until they figure out what to do next with the health insurance market. That will provide a transition period, they say, before Americans’ current insurance is yanked away.
“I don’t think we can do a repeal without a replacement. People are already in the system.”
“We are not going to rip health care away from Americans,” Rep. Kevin Brady (R-TX) told the New York Times on Friday. “We will have a transition period so Congress can develop the right policies and the American people can have time to look for better health care options.”
But health policy experts warn this approach will be a disaster. Trying to delay the implementation of a looming Obamacare repeal will sow chaos and uncertainty in the health insurance industry. As soon as the law is officially repealed, insurers participating in its existing state-level marketplaces will balk — imperiling the same marketplaces that Republicans would be counting on continuing until they figure out what to do next.
It’s no wonder, then, that some Republicans aren’t supportive of this emerging “repeal-and-delay” strategy. Several sources told the Hill that moderate lawmakers are “getting skittish” about the prospect of rushing to repeal Obamacare and then being left to piece the insurance industry back together ahead of the 2018 midterm elections.
Opponents of “repeal-and-delay” aren’t eager to leave millions of people hanging in the balance before there’s a clear next step.
“In my view, the repeal is not nearly as important as replacement,” Rep. Dennis Ross (R-FL) told Bloomberg. “To just say ‘repeal everything, and the mandates, without a replacement,’ then what? I don’t think we can do a repeal without a replacement. People are already in the system.”
Making matters more complicated is the interplay between the Affordable Care Act’s provisions, which makes it difficult to pick and choose between the different components of the sprawling law.
Some Republicans — including President-elect Donald Trump — have expressed a desire to maintain the law’s most popular consumer protections, such as allowing young adults to remain on their parents’ insurance plans until age 26 and preventing insurers from discriminating against people with pre-existing conditions. But it’s difficult to keep Obamacare’s popular provisions intact without simultaneously maintaining the law’s less popular policies, like the individual mandate that requires every American to have insurance. If insurers aren’t allowed to deny coverage to sick people, but there isn’t any requirement for all Americans to purchase coverage, premiums will skyrocket as a flood of sick people enter the market without enough healthy people to balance them out.
So far, it’s not clear how Republicans plan to handle that. It’s also not clear how they plan to address the fact that every GOP-proposed health care plan that has been put forth over the past several years will result in fewer Americans having access to insurance.
One thing is sure. The path forward is going to be a lot more challenging than crafting talking points against Obamacare.