Republicans Consider Obamacare Repeal Without A Replacement Strategy

Republicans have spent a lot of time in recent weeks vowing to repeal Obamacare. But, it is quickly becoming apparent that, since precisely zero people expected the 2016 election cycle to end with Republican control of all three branches of government in Washington D.C., no viable alternative has been fully vetted and stands ready to replace the failed legislation. According to Bloomberg, the lack of a fully negotiated replacement option could result in Republicans repealing the bill on a piecemeal basis with a replacement to be implemented at a later date.

“They haven’t come to a consensus in the House and the Senate about the possible replacement plans,” said Douglas Holtz-Eakin, a conservative economist and former adviser to Senator John McCain’s 2008 presidential campaign. “They don’t know Point B.”

Republicans are debating how long to delay implementing the repeal. Aides involved in the deliberations said some parts of the law may be ended quickly, such as its regulations affecting insurer health plans and businesses. Other pieces may be maintained for up to three or four years, such as insurance subsidies and the Medicaid expansion. Some parts of the law may never be repealed, such as the provision letting people under age 26 remain on a parent’s plan.

While Trump has repeatedly called for expanding the use of Health Savings Accounts and allowing insurance companies to sale policies across state lines, none of those policies have been officially written into a bill at this point. And while dozens of Obamacare alternatives have been introduced in Congress over the years none of them have actually received enough support to get off the ground.

Trump and House Speaker Paul Ryan of Wisconsin have been vague on what they want to see, but both released blueprints calling for expanding the use of tax-advantaged Health Savings Accounts, allowing the sale of insurance across state lines and turning Medicaid over to states. Republicans are seeking recommendations from governors and industry leaders on what to do.

In nearly seven years since Obamacare passed, dozens of comprehensive health-care alternatives have been introduced, but none has gotten off the ground. The most developed plan so far is legislation by House Budget Chairman Tom Price of Georgia, Trump’s nominee to run the Department of Health and Human Services, which he introduced in every Congress since 2009. It had 84 cosponsors in the House.

But that bill — centered on age-based refundable tax credits to buy insurance — didn’t receive a hearing in committee, nor was it included in Price’s budget that was adopted by the House last year.

Of course, taking away taxpayer-funded freebies is always more difficult than expected in practice…a concept that Democrats have used to their advantage to oversee a massive expansion of the federal government that has been underway for nearly a century now. While many Democrats, like incoming Senate Democratic Leader Chuck Schumer, seemingly welcome a repeal of Obamacare on the basis that it will allow the party to re-establish it’s base in 2020, we suspect they are underestimating how disgusted the overwhelming majority of American’s are with premiums that have soared over 100% in certain parts of the country in 2017.

Democrats have made clear they won’t go along with Republican attempts to repeal Obamacare. Some are taunting the GOP as it attempts to write a replacement.

“Bring it on,” incoming Senate Democratic Leader Chuck Schumer of New York said this month. “They don’t know what to do. They’re like the dog that caught the bus.”

Several of the law’s provisions are popular, most notably the regulations prohibiting insurers from denying coverage or raising costs on people with pre-existing conditions. And of the 14 states with the largest percentage of non-elderly people with pre-existing conditions in 2015, Trump carried 12, according to a Kaiser Family Foundation study released last week. He also got one electoral vote in Maine, the 13th state in that group.

Congressional Republican aides say they’re likely to soften those rules by limiting their protections to people who maintain continuous coverage.

“The pre-existing condition provisions in Republican proposals are less protective,” Levitt said. “With fewer protections you could piece together other mechanisms to keep the market stable.”

Trump has proposed high-risk pools to cover sick uninsured people, but financing them will be a challenge. A 2010 estimate in National Affairs by conservative health-care experts Tom Miller and James Capretta pegged the cost at $150 billion to $200 billion over a decade to insure up to 4 million people; House Republicans have been reluctant to spend anything close to that.

While Democrats, like Chuck Schumer, are great at using the mainstream media to deliver eloquent speeches and taunt Republicans, we’re pretty sure the majority of American understand that this is the definition of failure: