Congressional Republicans are setting up their own, self-imposed deadline to make good on their vow to replace the Affordable Care Act. With buy-in from Donald Trump’s transition team, GOP leaders on both sides of the Capitol are coalescing around a plan to vote to repeal the law in early 2017 — but delay the effective date for that repeal for as long as three years.
They’re crossing their fingers that the delay will help them get their own house in order, as well as pressure a handful of Senate Democrats — who would likely be needed to pass replacement legislation — to come onboard before the clock runs out and 20 million Americans lose their health insurance. The idea is to satisfy conservative critics who want President Barack Obama’s signature initiative gone now, but reassure Americans that Republicans won’t upend the entire health care system without a viable alternative that preserves the law’s popular provisions.
“We’re talking about a three-year transition now that we actually have a president who’s likely to sign the repeal into the law. People are being, understandably cautious, to make sure nobody’s dropped through the cracks,” said Senate Majority Whip John Cornyn (R-Texas).
The tentative strategy is reminiscent of Capitol Hill’s infamous “fiscal cliff” days, when Congress imposed simultaneous deadlines to raise the debt ceiling, extend expiring tax cuts and fund the government. The hope was that it would create irresistible political pressure to get behind a bipartisan mega-fiscal deal.
This time, however, it’s access to health care for tens of millions of people that’s on the line.
I understand the conservative instinct to say: Three years? Rip off the damn bandage!
But it's not that simple. You can't just repeal ObamaCare and go back to what we had before it was passed. What we had then doesn't exist anymore. ObamaCare destroyed it. It would be like trying to un-bomb Hiroshima. The replacement can't simply reflect a vision that says, "It would be better if we did it this way." It has to clean up the mess ObamaCare created - and it's a very complicated mess.
You've got more than 10 million people now dependent on insurance policies subsidized by taxpayers.
The policies people used to like no longer exist, and some of the health provider networks that existed pre-ObamaCare have either been narrowed or eliminated entirely.
Some states set up exchanges while others did not, prompting the federal government to set up its own. That's made a total mess of the health insurance market, as many insurers have exited the exchanges in certain states after losing a fortune, and some have exited them in every state. Transitioning back to a free insurance market isn't just a matter of signing a decree to make it so. You've got to figure out how to aborgate economic relationships and give insurers time to once again design new plans and policies to reflect the real state of the market.
Like it or not, the public is not going to accept if you return to the days when people with pre-existing conditions couldn't get insurance. You can come up with a better way to deal with the problem than simply requiring everyone to accept them without conditions, but you've got to come up with something.
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About half the states expanded Medicaid under ObamaCare with the promise of federal subsidies. What do you do with that? What do you do with all the people who were added to the Medicaid rolls as a result? You need to come up with something.
So the gambit, as I understand it, is to eliminate ObamaCare in two steps. The first thing you do is pass a repeal bill that establishes a date certain by which ObamaCare will be repealed, no questions asked. That could be on Trump's desk to sign very early in his presidency. Then, between the date the bill is signed and the date when repeal is effective, Congress and the White House have to decide on how the transition and the new plan will work.
One theory, I guess, is that Democrats will work with you more constructively if any hope of saving ObamaCare is gone, thus depriving them of any incentive to continue demagoguing on its behalf. I guess, but why can't you come up with the replacement plan and pass it at the same time you pass the repeal? There's going to be a transition period regardless, but if you sign the replacement plan into law at the same time as the repeal, here's the danger: The "date certain" in the repeal bill isn't that certain after all. I can envision someone like Mitch McConnell sneaking in language that provides a caveat - that if no replacement plan is established - the repeal would not take effect. That gets Congress off the hook if they can't work out a plan by the date certain. And if control of Congress or the White House changes in the meantime, ObamaCare might not be a goner after all.
If the Republicans risk that happening after they take control of all branches of government, they're going to be proving once again why so few people really have confidence in them to govern effectively.
No one says this is going to be easy. Cleaning up the ObamaCare mess is going to be difficult, and it's absolutely wrought with political peril for the Republicans as they take on the task. But that's the nature of governing. They've got to work out a replacement and pass it into law quickly, lest they get bogged down in a process that ultimately yields no solution, and keeps ObamaCare in place as the devil we know.
The voters didn't decide on November 8 that they want to keep those familiar devils around. Get rid of them.
