Tough Choices Loom on Long Road to Replacing Obamacare
  • Mon, 01/09/2017 10:03 PM

For the last seven years, Republicans have failed to budge President Obama on health care reform despite numerous attempts. Now the GOP is in the driver’s seat and the politics are only more treacherous. Despite the GOP leaders eagerly looking forward to replace Obama's signature legislative accomplishment, the Affordable Care Act with more free market principles, the path is still long, complicated and extremely risky even to the entire insurance system.

Biggest issue is that no perfect replacement is possible. Like Obamacare, any replacement will inevitably create new winners and losers and thus a long and agonizing path lies ahead. Aaron Carroll, a health care researcher ruled out any way to cover more people with higher quality and cheaper price. Under Obama, Republicans were unanimous in their opposition. Keeping their fingerprints off the ACA in 2010, they made the Democrats accept full political responsibility for the entire health care industry by ensuring not even a single GOP vote. With dynamics reversed now, Republicans will have to fix the system and now own it completely. Lawmakers need to perform the Herculean task of finding a health care that will not only please conservative activists, business groups and voters but would also eventually win Democratic support.

Many of Trump’s supporters are expecting better, cheaper health coverage even if it means more expense for government and look up to Trump to fulfill his pledges regardless of whatever philosophy is behind it. The next four years will be full of collisions. Though no one knows the resulting system, its general road map is being chalked out.

The Immediate challenge for Republicans is to repeal large chunks of the Affordable Care Act while the long term challenge is to work out its replacement. Both are inter-related since decisions made on a repeal bill affect their options on the replacement. The repeal bill will be different from most legislation since it will rely on an obscure parliamentary maneuver called reconciliation under which the Senate will pass certain budget items with only a bare majority. Here Republicans do not need any Democratic votes but they have to follow rules which limit what they can include in the repeal measure. While Trump’s team generally agree to let people under Obamacare subsidies keep it while they work out alternatives, they disagree on how long it should last. Some want it for four years but some do not want it to exceed two years.

Sen. Rand Paul feels Republicans need to pass a replacement simultaneously. Many conservative policy experts agree with him. The American Medical Association wants the GOP to detail its replacement plan first. However, many on the right want the Senate leaders to challenge parliamentary rules and repeal the entire bill outright in one fell swoop.

Ultimately, with a 52-seat Senate majority now, the Republicans would have to come up with a bipartisan deal to overcome the Democratic filibuster with 60 votes and achieve a full replacement. Hard deadline for repeal might get the two parties to compromise for a permanent fix which may not be far off from Obamacare in coverage. Or it might destroy the entire health care system.

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