Newsy if true. At the moment the GOP’s strategy on ObamaCare is “repeal and delay,” i.e. pass repeal immediately but delay its effective date until, say, January 1, 2019. That would give Republicans nearly two years to work out a replacement to the O-Care health insurance exchanges. The alternative is to hold off on repeal until that replacement is ready, but Republican voters won’t like having to wait years to see their dream of undoing ObamaCare come true. The longer Republicans in Congress wait, the greater the risk that they’ll get cold feet and/or decide that they can’t agree on a replacement, which would mean no repeal after all. The base’s faith in its leadership would be finally and totally shattered. And the closer we get to 2018, the more dangerous that becomes. Although the Senate map in the midterms strongly favors Republicans, there’s always a chance that Democrats will have a big night and pick up three seats — which would hand control of the Senate to Chuck Schumer in 2019. That would be the end of repeal. The GOP would have blown its chance to kill ObamaCare. They’d never be forgiven.
Those appear to be the two options, though — repeal now and delay implementation until a replacement is set to go (“repeal and delay”), or wait to repeal until the replacement is ready and then do both simultaneously (“repeal and replace later”). A few Republicans, like Susan Collins and Tom Cotton, appear to favor the latter approach. But … could there be a third option? Namely, “repeal and replace ASAP”?
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
Assuming that’s true, it’s consistent — sort of — with what Trump told “60 Minutes” in November:
Lesley Stahl: And there’s going to be a period if you repeal it and before you replace it, when millions of people could lose -– no?
Donald Trump: No, we’re going to do it simultaneously. It’ll be just fine. 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 It will be repealed and replaced.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 we’ll know. And it’ll be great health care for much less money. So it’ll be better health care, much better, for less money. Not a bad combination.
The GOP’s plan isn’t to repeal the law immediately and have “nothing” for two years. They’ll keep the exchanges going (even if it requires bailing out insurers so that they don’t flee the program once repeal passes) until their replacement system is done. Still, Trump was open to simultaneous repeal-and-replace as recently as two months ago. On the other hand, he warned Republicans a few days ago not to let themselves be seen as having wrecked the health-insurance system by uprooting ObamaCare too hastily. Let the law fail under its own weight, he said, to prove to Americans that it was the Democrats’ poor design that wrecked their coverage, not the GOP’s repeal initiative. That would seem to point towards “repeal and replace later.” Now here’s Paul suggesting that Trump might be open to “repeal and replace ASAP.” Go figure.
There’s one big problem with “repeal and replace ASAP,” of course. Er, there’s no replacement yet. The GOP doesn’t have a bill for its caucus to consider; it doesn’t even have a consensus plan to serve as the basis for a bill. What it has are some broad principles of how the insurance system should look. Paul laid out some of them in an op-ed a few days ago in which he called for repealing and replacing the law simultaneously and immediately. (“Congress will, as its first course of action, vote to repeal Obamacare. It cannot happen soon enough.”)
What should we replace Obamacare with? Perhaps we should try freedom:
1. The freedom to choose inexpensive insurance free of government dictates.
2. The freedom to save unlimited amounts in a health savings account.
3. The freedom to buy insurance across state lines.
4. The freedom for all individuals to join together in voluntary associations to gain the leverage of being part of a large insurance pool.
He talked a little about that in an interview on Fox Business yesterday, embedded below. I’ll have draft legislation ready soon, he vows, which is nice if you think the House and Senate might rubber-stamp his plan but not so encouraging back in the real world, where Trump and Tom Price and Mitch McConnell and Paul Ryan and Kevin Brady and dozens of other members in both chambers will want to tweak whatever consensus plan the party ends up settling on. This sausage won’t be made in a few weeks; it probably won’t be made in a few months. One of the reasons “repeal and delay” got traction in the first place is because it’ll take time for the party to hash out its differences over health care and fine tune the bill that establishes the new insurance system before it becomes law. If the GOP rushed a new system into place and it wasn’t well thought through, with people losing their insurance or other major unintended consequences resulting from the disruption, they’d risk a hellacious beating over it from voters — precisely what Trump was worried about earlier this week. In which case, why is PEOTUS backing “repeal and replace ASAP”? Replace with what?
The basic difficulty here for Republicans, I think, is that they’re caught between two constituencies on whether to set a deadline for repeal. Republican voters want a deadline. Maybe they’d tolerate a slight delay on repeal — for example, if Trump personally guaranteed that ObamaCare would be repealed by the end of the year. That would give Congress upwards of 12 months to draft a replacement, at which point they could repeal and replace simultaneously. But any deadline for repeal, even an informal one, risks spooking insurers, and the more insurers see the exchanges as doomed, the less incentive they have to keep offering plans there. Somehow the GOP needs to convince grassroots Republicans that repeal is happening while at the same time convincing insurers that repeal might not be happening, which would be a neat trick. That’s what “repeal and delay” tries to do as best it can, but as noted earlier, it’ll probably also require promising to bail out insurers who incur losses if they agree to keep participating in the exchanges while the process of replacing of ObamaCare is ongoing. It’s also why Paul, one of Congress’s staunchest fiscal conservatives, hates “repeal and delay.” He knows that if the mandate is repealed soon and the exchanges start to wobble, the GOP will be stuck indemnifying insurers. His plan is a way, in theory, to avoid shoveling money at the industry to keep ObamaCare buoyant for a few years, but I don’t know if it’s avoidable.
One last point. You’ll need eight Democratic votes in the Senate to pass a replacement bill. Are you more likely to get those votes now, which is what you’d need for “repeal and replace ASAP,” or are you more likely to get them in late 2018, which is what you’d need in one of the other strategies? The argument for “now” is that Trump just won a huge populist upset victory and might well be at the height of his political power. Red-state Democrats might be nervous about opposing him at the moment. The argument against that is that the left is smarting from its defeat and spoiling for an opportunity to show Trump that it’s still a force to be reckoned with. Red-state Dems would come under enormous pressure from their base to make a stand and protect Obama’s legacy if the GOP forced a gut-check vote to replace the law this year. The climate in 2018 is harder to predict, but many of those Democratic senators from red states are up for reelection that year and will be taking a major risk in joining a filibuster of the GOP’s replacement plan with the election just months away. My hunch is that they’d be more likely to cave then than now, especially if Trump’s first two years as president are successful, but it’s a gamble.