Repeal and delay won't work -- politically or functionally

After almost seven years of opposition to ObamaCare and the pledge to repeal and replace it, a new idea got floated this week, according to Politico. John Cornyn, Kevin McCarthy and other Republicans have begun talking about a three-year process of replacing ObamaCare, which would put it in the middle of the next presidential election, as Allahpundit noted yesterday. Philip Klein responded with a practical question and answer — why would insurers bother to stick around in the ACA exchanges for the next three years if ObamaCare is going to be repealed anyway?


For one, there’s no guarantee that insurance companies will continue to participate in Obamacare over the next several years knowing that the law is going to be repealed.

Over the first few years of Obamacare’s implementation, insurers have lost billions of dollars trying to sell insurance through Obamacare. Many of them are willing to stick it out, for now, in hopes that they could establish a foothold in the young market and be in a position to profit if and when it stabilizes. But that calculation changes dramatically if they know that after several more years of racking up losses, the market is going to expire anyway. Many more insurers are likely to exit ahead of the 2018 year, disrupting people’s insurance arrangements.

Additionally, the political landscape could change dramatically between now, when Trump and congressional Republicans have just come off a huge election victory, and the 2018 midterms, when the party in power historically suffers setbacks. President Obama came into office with much stronger political standing in 2009 than President-elect Trump will, and within two years, he had completely lost his ability to achieve any of his domestic policy goals.

The idea that Republicans, in the second half of Trump’s first term, with the 2020 election heating up, will be in a better position to pass an Obamacare replacement than they are now, is inconceivable.


Klein is absolutely correct, in all but Senate numbers, anyway. The thought process on this is probably that Republicans stand to gain several seats in 2018, perhaps enough to have a filibuster-proof majority. At that point, they can pass anything they want. That’s true, at least functionally, but people seem to forget that Democrats thought the same thing and forced ObamaCare through oin a party-line vote despite popular disapproval. How did that work out for them over the last six-plus years?

That also assumes, by the way, that Republicans would do well in the midterms after kicking ObamaCare down the road despite having single-party governance for the first time since its passage. If they renege on this promise under these conditions, those midterms might look a lot less sunny.

Republicans need to take a lesson from 2009-10 and find a way to work with Democrats in order to spread the ownership. They should make it very clear that ObamaCare will be repealed and dismantled at the end of the 2017 insurance year, and that something will have to take its place. As I write in my column for The Fiscal Times, Republicans hold enough cards as it is with Tom Price and Seema Verma at HHS:

Price has attempted to repeal and replace Obamacare since before its passage. Democrats have repeatedly accused Republicans of having no alternative to the ACA for health insurance reform, but Price introduced a bill in July 2009 that would have offered reform on free-market principles rather than a federal government takeover of the insurance markets. …

While a full repeal would have to originate in Congress, Price’s nomination promises quick action to roll back regulatory changes that come from the blank-check authority given to HHS by the ACA. The controversial contraception mandate will almost certainly be at the top of that list. Price has opposed that from the moment Kathleen Sebelius issued the regulation, specifically citing its infringement “with our fundamental right to religious freedom.” …

Democrats have been quick to counter with accusations that Trump and his new administration will leave low-income Americans without health coverage. Obamacare also expanded Medicaid, which most states have adopted, and which accounts for nearly half of the claimed 20 million consumers who gained insurance after its adoption. Repealing Obamacare, its advocates claim, will leave those Americans in the lurch.

Trump’s second appointment this week provides a clear answer to those accusations. Seema Verma will take over the Centers for Medicare and Medicaid Services after having worked with vice-president elect Mike Pence to craft Indiana’s Medicaid expansion, as well as with Kentucky’s Matt Bevin and a handful of other Republican governors. Verma helped create Healthy Indiana 2.0 plan (HIP), a program that mixes the base coverage of Medicaid with tax credits and HSAs to produce incentives making utilization more efficient and effective.


To use a medical analogy, ObamaCare is a Band-Aid that must be ripped off at once, rather than pulled tortuously for three years. Republicans might have to give some in order to replace it, but taking it off the table first and emphatically is the only way to get Democrats working on whatever follows it. As long as it’s still hanging around, Democrats will not budge or work with Republicans on its successor.

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Jazz Shaw 2:01 PM on December 06, 2023
Jazz Shaw 12:01 PM on December 06, 2023