Do Republican Defections Spell the End of the Obamacare Repeal?

Despite their dogged pursuit of an Obamacare repeal, Republican leaders may no longer have the votes to dismantle the law without a viable replacement--and may have blown their chance of destroying President Barack Obama's healthcare plan altogether.

Two dozen Senate Democrats took part in a five-hour "talkathon" into the early hours of Tuesday, protesting the effort to dismantle the Affordable Care Act (ACA), summarized by Sen. Elizabeth Warren (D-Mass.) as a plan to "repeal and run," which could leave up to 20 million Americans without health insurance.

And while the Democrats see the Obamacare debate as their "first big fight against the Republican majority and the Trump majority," as minority leader Sen. Chuck Schumer (N.Y.) put it, a growing number of Republicans are now also voicing concern ahead of the vote.

"Something big is happening in the Senate right now," New York Magazine's Jonathan Chait wrote late Monday. "The Republican plan, affirmed again today by Senate Majority Leader Mitch McConnell, is facing dire peril from Republican defections. Republicans need a House majority, 50 Senate votes, and soon-to-be President Trump to pass repeal and delay. If Republicans lose three Senate votes, that drops them to 49, and repeal and delay cannot pass."

Currently, the vote on the shell budget resolution that lays out the guidelines for repealing the ACA is scheduled to take place Friday. But five Republican senators--Sens. Bob Corker (R-Tenn.), Rob Portman (R-Ohio), Susan Collins (R-Maine), Bill Cassidy (R-La.), and Lisa Murkowski (R-Alaska)--have introduced an amendment to "extend the deadline for budget reconciliation instructions until March 3, 2017, and ensure a responsible process for replacing President Obama's health care law as quickly as possible."

Throwing more cold water on the effort, members of the Tea Party-backed House Freedom Caucus are also calling for the party to "slow down the process so that we can understand a little bit more of the specifics, the timetable, replacement votes, reconciliation instructions, etc.," as chairman Rep. Mark Meadows (R-N.C) told reporters late Monday.

What's more, Chait notes, "numerous Republican governors--who don't have a vote on it but can nonetheless exert pressure--are lobbying Washington Republicans to protect the parts of the law that their states rely on."

With the vast majority of Americans opposed to dismantling Obamacare "until the details of a replacement have been announced," as a recent Kaiser Family Foundation survey found, the growing dissent among lawmakers is not surprising.

"But more time isn't going to help," Chait observes. There is "never going to be a Republican plan," he argues, "because it is conceptually impossible to design a health-care plan that meets conservative ideological goals and is also acceptable to the broader public."

Further, he points out, unless the GOP can muster the 50 votes needed for the "repeal and delay" strategy, they will have effectively lost their "best chance to destroy Obamacare. "

He explains:

The insurance regulations--requiring insurers to cover essential benefits, not discriminate against people with preexisting conditions, and so on--aren't taxes and spending. They can only be altered with a regular bill, subject to a filibuster. That means if Republicans want to actually put a new system into place, and not just turn the health-care market into a smoking crater, they need at least eight Senate Democrats to join them.

What that means is that replacing Obamacare at the same time it's repealed would create completely different parameters for what happens next. There aren't going to be eight Democrats willing to support a right-wing bill that throws people into catastrophic coverage plans that don't cover basic medical care, as conservatives would like. It would be a coalition to patch up Obamacare with incremental changes. Maybe Republicans would call it "repeal" of Obamacare and "replacement" with something that's about 90 percent similar, but that would be symbolic. A bipartisan law would advance Obamacare's goals rather than destroy them.

Facing intra-party dissent, House Speaker Paul Ryan (R-Wis.), Senate Majority Leader Mitch McConnell (R-Ky.) are hoping to squeak by with a new strategy, Politico reports, "that includes adding some replacement provisions to the repeal bill."