For six years, Republicans have voted more than 60 times to repeal and replace the Affordable Care Act. “Repeal and replace” was a staple of Donald Trump’s stump speech. Give us control, Republicans promised, and what Mike Pence promises as the “first order of business” will be repeal and replace.
Only one problem: There is no plan. Republicans have hundreds of ideas but no replacement plan and no consensus. So now the same politicians who couldn’t come up with a serious plan in six years are considering a new idea: repeal now and replace later. Use the arcane rules of a “reconciliation” bill to push through repeal; replacement plan to come later. Promise. Trust us, they say, we’ll come up with something in a few months, or a couple of years, with a “few bumps along the way,” as Senate Majority Leader Mitch McConnell (R-Ky.) said . (“Bumps” is a euphemism for sick Americans losing health care, giving new meaning to the phrase “road kill.”)
This isn’t just harebrained and irresponsible; it is immoral. Twenty million Americans have gained health coverage under Obamacare. Young adults are covered under their parents’ plans. People with preexisting conditions have been able to get affordable coverage for the first time. Medicaid has been extended to cover the families of millions of low-wage workers, many of them Trump voters. The rise of health-care costs has slowed due to intricate reforms in the law. The extension of care has been paid for largely by taxes on the rich.
Repeal without a ready replacement would quickly unravel this complicated arrangement. Insurance companies aren’t philanthropic organizations. They would start to raise prices and curb coverage immediately if they saw the current deal likely to get worse. Hospitals and doctors would start to unravel cost-saving efforts. Millions — literally millions — of Americans would be at greater risk. This isn’t simply about dollars and sense. This is about lives and health. People will die if newly affordable coverage is stripped from them.
Worse, it isn’t clear at all that Congress can pass a plan to replace health-care reform once it is repealed. Democrats will oppose efforts to roll back Medicaid, repeal progressive taxes and put people even more at risk. The entire Congress could face extortion from the House Freedom Caucus, the uber-right-wing caucus that wants to roll back not just Obamacare, but Medicare and Medicaid as well. Repeal and delay could easily turn into repeal and collapse.
Why is there no plan to replace? Simply because Republicans haven’t been serious. In opposition, led by House Speaker Paul Ryan (Wis.), they could rail about Obamacare, and promise the moon — everyone covered at lower costs and with lower taxes, all from the genius of markets. For years Ryan and company promised budgets that could cut taxes and spending without harming people (details to come later) and health-care replacement that would cover everyone at less cost (details to come later). Now later has arrived. And Ryan says . . . later.
Beneath this is the secret reality: Obama stole their plan. The ACA drew heavily on the right-wing Heritage Foundation plan that was modernized by Mitt Romney in Massachusetts. Obama added reforms to slow price hikes, further extend Medicaid coverage of low-wage workers, and more, but the core was the same: pooled coverage in “exchanges,” enforced by a mandate that everyone have insurance. To get his bill passed and to appeal to Republicans, he even abandoned the public option and sustained the wrongheaded ban on the government negotiating bulk discounts with drug companies.
Republican senators have begun to realize that this could blow up in their faces. Rand Paul (Ky.), Tom Cotton (Ark.) and Bob Corker (Tenn.) have called for repeal and replace to occur simultaneously. Susan Collins (Maine) and John McCain (Ariz.) have expressed worries about repeal and delay. As The Post’s Greg Sargent has noted, more than 20 Republican senators come from states that have expanded Medicaid under the ACA, benefiting millions. Since no Democrat will sign up, “no” votes from only three Republican senators are all that is needed to bring an end to the folly. (But of these profiles in hand-wringing, only Paul has pledged to vote against.)
President-elect Donald Trump has stated — well, tweeted — that Republicans should be careful about repealing Obamacare without a plan to replace it. If he were wise, he’d pull the plug on this scene by promising to veto any repeal that isn’t accompanied by a good plan to replace. But Trump is even more of a con man than Ryan, so he seems worried more about the optics of the deal than its effects on Americans at risk.
You can fool all of the people some of the time, but on health care, the people are cautious.
In a rational world, Congress would amend the ACA to move closer to Medicare for all. It could make those 55 and older eligible for Medicare, taking a big burden off businesses, and pay for it with a financial transaction tax that would curb nanosecond computerized trading. It could allow negotiation of bulk discounts from drug companies. But common sense isn’t in evidence in this Republican Congress.
Instead, extreme partisanship is the order of the day. As Trump has demonstrated, a big con can take you a long way. But is it really too much to ask that when dealing with the lives and health of Americans, Republicans figure out what they want to do before they torpedo what exists? This isn’t a high bar. A little adult supervision would be all that is needed.