Way back in March 2010, when congressional Republicans were incensed that America was poised to join the western world by offering health coverage to those who lacked it, they came up with a catchy slogan for Obamacare: “Repeal and replace.” The only problem was, they had no clue what to replace it with.
And nearly seven years later, they’re still clueless.
How easy it was, during the Obama era, for Republicans to pass repeal bills, knowing full well that their gestures were meaningless, that they’d never have to make real policy choices, that they’d never have to actually govern.
But life is different now. Now they run Washington. Now they have to take responsibility for their actions. Now that they’ve already taken the first steps to repeal Obamacare — via bills that passed last week — they have to figure out how to replace it without jeopardizing the health and finances of the 20 million Americans who’ve benefited from the law.
And yet, Republicans still can’t agree on how to do it. Heck, they can’t even agree on when to do it.
A sizeable faction is calling for repeal-and-delay; in other words, kill the law but take a bit of time to craft a reasonable replacement, because, hey folks, this stuff is complicated. Problem is, Republicans had seven years to come up with something, and they never did — so why should anyone believe they’ll pull a policy miracle and do it any time soon?
Indeed, killing Obamacare and leaving coverage in limbo for awhile would be a “total disaster,” in the words of J. B. Silvers, a former health insurance company chief executive. He warns today that “whoever plays games with (health coverage) — knowingly or inadvertently — is playing with fire.”
So while lots of Republicans are pleading for enough time to figure things out, health policy scholar Donald Trump is pushing for an instant solution. This weekend, he told The Washington Post that he’s currently putting the “final strokes” on a replacement plan, which means one of two things: He’s smarter than every Republican think tank, or he’s just lying again.
Point is, on the timeline issue, he and congressional Republicans are not on the same page. We’re going to see a lot of that.
While party leaders like Paul Ryan are pleading for “a little bit of time” to figure out a replacement, Trump wants it done now. Which is what you’d expect from a guy who has zero experience or understanding about the complexities of policy and the incremental grind of government. Here’s what he promised, in his trademark semi-gibberish, during his “news” conference last Wednesday:
“You will be very, very proud, not only as the media and reporters, but you’re going to be very proud of what we put forth having to do with health care … We’re going to be submitting as soon as our (Health and Human Services) secretary is approved, almost simultaneously, shortly thereafter, a plan. It will be repeal and replace. It will be essentially simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day. Could be the same hour.”
Sounds like just another con from the Don. The Senate committee that’s tasked with vetting HHS nominee Tom Price hasn’t even scheduled hearings yet, so the timeline for any replacement is already elongated. And Republicans are still flummoxed on substance. Trump is promising “insurance for everybody,” but the only way to do that is to have mandates, subsidies and taxes — the kind of stuff embedded in Obamacare, the stuff that Republicans rotely abhor.
Indeed, Republicans say they want to keep some key Obamacare provisions (including guaranteed coverage for people with pre-existing health woes; and young adults staying on their parents’ plans until age 26), but they can’t figure out how to do that without those mandatres, subsidies and taxes. They want to pledge renewed fealty to the “free market,” but if they reduce the federal subsidies to Obamacare recipients (many of whom are white blue-collar Trumpkins), they’ll push many of those folks toward lousier health plans with higher deductibles, more out-of-pocket spending.
And Republicans, including Trump, are also bent on allowing insurers to offer health plans across state lines. Problem is, that “free market” solution will hurt the states that strictly regulate insurers — with real-life consequences for sick people.
As one health care expert rightly points out, “Interstate sale would allow insurers from states with little regulation to offer low-cost, stripped-down plans in states that require comprehensive benefits. If healthier consumers from the comprehensive states flock to those skimpier plans, the families with greater medical needs left behind could face vastly higher costs.” Plus this: “Even older and sicker people with employer-provided coverage would pay more if Congress repeals the reforms limiting out-of-pocket expenses and preventing insurers from imposing annual or lifetime benefit caps.”
Sorry I got a little wonky there. But it gives you a taste of what Republicans are dealing with, now that they actually have to govern.
Obamacare, albeit imperfect, has at least sought to solve the longstanding health coverage crisis. When George W. Bush and the Republicans controlled Washington, they had years to come up with their own vision of health reform. They never did. Indeed, they had little political incentive; most of their voters were either employed with insurance, or retired with socialist Medicare. As a result, Obamacare filled the vacuum — and now Republicans are stuck trying to figure out (right away? with a long timeline?) what to do with 20 million beneficiaries.
As for the party’s “repeal and replace” slogan, the Republican guy who originally coined it now says the slogan worked politically because it “had sort of a catchy ring to it.” But, dare we ask, how exactly do you replace what you repeal? In response, the guy laughingly says, “I don’t do policy.”
Are we surprised?
This just in: The nonpartisan Congressional Budget Office says in a new summary that, based on what it knows today, a Republican repeal of Obamacare will ultimately increase the number of uninsured Americans by 32 million – and double the price of insurance premiums within a decade. That’s the GOP we all know. Cue the Trump tweets sliming the CBO.