Republicans plot to kill Obamacare with a thousand cuts

Well prior to the 2014 midterm elections, which saw Republicans net their largest majorities in both chambers of Congress since World War II, incoming Senate Majority Leader Mitch McConnell (R-KY) promised that among his highest priorities would be the dismantling of Obamacare.

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According to an illuminating report in Politico, this is not just talk. McConnell is meeting with budget experts, parliamentarians, and GOP conference leaders in order to determine their best options with the aim of dealing Obamacare a variety of cuts that will cumulatively result in a fatal blow.

In a session with about a dozen senior GOP aides last month, the staff director for Republicans on the Senate Budget Committee privately laid out various scenarios that could occur when the Senate’s parliamentarian weighs in on the GOP’s Obamacare moves.

And the conservative Senate Steering Committee has put together three giant binders of information detailing the budget wars dating back to 1986, turning piles of data into a 28-page PowerPoint presentation being distributed to senators and staff laying out the kinds of procedural hurdles that could thwart their efforts. The process they are considering, known as “reconciliation,” has been used by Congress in the past to avoid a minority’s filibuster of controversial bills, including Obamacare itself.

While no one believes repealing the Affordable Care Act is feasible with President Barack Obama still in office, Republicans are eager to use a special procedure that might let them kill at least a large piece of the law — potentially the Medicaid expansion, subsidies for purchasing health insurance or even the individual mandate — with only a simple majority.

The Politico report includes this tantalizing nugget for conservatives who back the mandate’s repeal via any means necessary: “GOP budget experts assume that the health law’s tax subsidies — the root of a 2015 Supreme Court case — as well as the Medicaid expansion and individual mandate — could qualify for repeal under reconciliation.”

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So, just how effective will this strategy be in the short term (e.g. the time between the swearing-in of the 114th Congress and when Barack Obama leaves office)? Those who hope to see the repeal of crucial aspects of the ACA like the individual mandate are likely to be disappointed.

Whatever the Senate does in the next Congress, Obama will still have to sign it into law. There is virtually no chance that the president will sign a bill that repeals elements of the ACA, let alone an aspect so critical that Obamacare architect Jonathan Gruber confessed that the ACA would collapse without it.

Moreover, if Obama were to veto a reconciliation bill focused on the repeal of elements of the ACA, Republicans would be unable to use that process to pass a tax reform measure – the supply-side Republicans’ great white whale. Those conservatives who eschew populism will surely demand the Senate GOP keep their powder dry so as to pass pro-growth legislation with a simple majority that has a chance of being signed into law.

There are, however, elements of the law that are so unpopular that their repeal could net the six Democratic votes necessary for passage outside the context of a budget reconciliation bill. The National Journal reported in November that the medical device tax may be one of these elements of the ACA that could be repealed in the next Congress:

Obamacare’s tax on medical devices is considered low-hanging fruit. Device-tax repeal could have passed the Senate with bipartisan support even before Tuesday’s elections, had it come up for a vote, and it could definitely pass under a GOP majority. Because it wouldn’t strike at the heart of the law, Obama might even sign it.

Revenues, including the device tax, will be easier targets than policies that sit closer to the core of the law’s coverage expansion. Republican aides have also mentioned the law’s tax on insurance policies as a possible target for piecemeal repeal.

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If the Senate does put the other aspects of the law up for a repeal vote in 2015, it will likely be a political maneuver designed primarily to communicate the seriousness of the GOP majority’s intention to ultimately repeal the law. It will shore up support among the conservative grassroots base and maybe drive a few donations the party’s way in the process.

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