You do not have to think Obamacare is perfect or even the best health-care system we can devise to think its repeal would be problematic, to say the least. It is one thing to vote to repeal it when the president was sure to veto it. It’s another to repeal it, knowing the president will sign it, and then have to accept the consequences.
House Minority Leader Nancy Pelosi, D-Calif., predicted Tuesday, “I don’t think they’re going to repeal the Affordable Care Act.” She pointed out that just keeping the parts Republicans favor, such as protection for Americans with pre-existing conditions, would be prohibitively expensive. (”The one thing that I think the Republicans are more interested in . . . are costs. What is the cost going to be to their constituents in the changes they want to make?”)
House Speaker Paul Ryan, R-Wis., insists that Republicans have to “stop the damage” being done now. But by cutting revenue to support the exchange subsidies, Republicans risk eliminating coverage for tens of millions. Ryan has yet to convince all Republicans that it is politically smart to yank the plug on Obamacare with no alternative ready to go. “We took your health care away, but trust us” isn’t a persuasive campaign message in 2018.
Moreover, news reports have brought to the fore a series of practical problems, as John C. Goodman points out. Republicans, he reminds us, “have had seven years to propose an alternative; and if they don’t have one by now, why would anyone expect they would have one in three years? No one does expect that, least of all the insurance companies. Insurance industry consultant Robert Laszewski predicts that a ‘repeal and delay’ bill would create enormous uncertainly and could by itself throw the exchanges into a death spiral.” Republicans may have to bail out insurance companies to keep them in the exchanges — something they swore they’d never do — until they can agree on something new.
A “repeal, chaos, something new” approach will, as I suspect, lose support as the moment of truth arrives. Senate Majority Leader Mitch McConnell, R-Ky., was already sounding cautious at his Monday news conference when responding to complaints from medical groups about a repeal-and-delay strategy: “Well, none of those people that you mentioned are happy with the status quo. They want changes, too. And we’re going to work with them to come up with a better system than this monstrosity that was left behind by the Obama administration.” Pestered for an answer, he said, “Yeah, I don’t know how many times I have to say the same thing, but we’re — we’re going to be working on the phase-in period and what it looks like once we get to step two. Step one is the Obamacare replacement resolution which we’ll turn to after the first of the year.” But once they take step one (depending if that includes a funding cutoff), the chaos, uncertainty and insurance stampede begins.
We confess to being surprised that Ryan doesn’t introduce the replacement plan first, using the ideas outlined in his “A Better Way” health-care plan. Does he not have the votes to pass it? Does it require taxes his members will not support? Does it not cover all the current Obamacare recipients? If there are serious problems like this, then a promise of repealing and replacing Obamacare is a phony one. In sum, if there is a viable replacement plan, introduce and pass it soon; if there isn’t one that can garner a GOP majority and get past a Democratic filibuster, they need to admit it. Then go about the business of trying to fix flaws in the existing system.
This is what “owning” the consequences of your actions means. This is not a white paper or an op-ed on a conservative ideal. This is about real people who have coverage already and have the expectation of continued coverage. The time to put the alternative out — one that Republicans promise would work better and save money — is now. Pelosi is betting there is no such plan that can get “buy-in” from all Republicans and sufficient Democrats to pass both houses. If she is right, repealing Obamacare in January is the ultimate con and a recipe for political disappointment on the scale we have not seen since the Obama promise that you could keep your doctor.