ObamaCare is in big trouble. With the election of a Republican president and the survival of Republican majorities in both the House and Senate, ObamaCare should be history.
But ObamaCare is not dead yet. The effort to repeal and replace it is going to face some serious obstacles - some of which are policy-related, like the problem of how you deal with people with pre-existing conditions, or of how you transition people who have signed up for subsidized policies. The left wants you to think that repealing ObamaCare means ripping people's health care away from them. The trick is to find a way not to do that, and it won't be easy.
But before you even get to that, you have get past some serious procedural.and political hurdles on Capitol Hill, particularly in the U.S. Senate.
The Republican majority there is not large. It looks like we'll end up with a 53-47 Republican margin once the Louisiana runoff is finished in December. That means a new nervous northeastern liberals could scuttle the whole thing. It also means you won't have an easy time getting rid of, or around, the filibuster - especially when you've still got senators like John McCain and Lindsey Graham who think the traditions of the Senate are more important than the priorities of the nation.
Or . . . especially when Mitch McConnell is still the Senate Majority Leader. Avik Roy of Forbes, who has been one of the leading experts on the realities of ObamaCare since it was passed, sees a difficult road ahead with a skittish leader like McConnell in the big chair:
To start, full repeal of Obamacare can’t happen unless 60 U.S. senators vote for it, thanks to the filibuster. And there aren’t 60 votes in the Senate for full repeal; if advocates are lucky, there will be 52. (In 2017, Republicans will control either 51 or 52 Senate seats, depending on the outcome of a runoff in Louisiana.)
Republicans could, in theory, get rid of the filibuster, but Senate Majority Leader Mitch McConnell (R., Ky.) and others have routinely expressed opposition to that idea. (And that’s a shame.)
The best that Republicans can do is to pass a partial repeal of Obamacare using the reconciliation process, which only requires 51 votes. Republicans did this in January, when they sent to President Obama’s desk the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015.
That bill would have repealed Obamacare’s tax hikes, Medicaid expansion, and insurance exchange subsidies, affecting more than 15 million enrollees. That’s a big deal, because it affects $2 trillion of spending over the next decade.
But critically, the partial repeal bill does not get rid of Obamacare’s tens of thousands of pages of insurance regulations, the regulations that are responsible for the law’s drastic premium hikes.
It may be that those premium hikes helped elect Donald Trump on Tuesday. So it would be ironic if that’s the part of Obamacare that a President Trump couldn’t repeal.
As much as I believe the Senate should get rid of the filibuster entirely, I recognize that even if McConnell is willing to do it - which is no sure thing - he might have a hard time keeping his own caucus together on the vote. If we can't get rid of the filibuster, there's another way to go on ObamaCare.
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Remember that ObamaCare passed on a reconciliation vote. This was a procedural tactic used at the time by Harry Reid because Ted Kennedy died in between the time the Senate first passed its original version and the time it passed the House. That meant the Democrats no longer had their filibuster-proof majority of 60 seats, so Reid chose to abuse reconciliation rules to pass the final version.
That provides a perfect opening for McConnell: If ObamaCare could pass on reconciliation, it can be repealed on reconciliation. I think it's a wimp-out compared with just getting rid of the filibuster altogether, but it will work.
A bigger question, though, is whether McConnell has the stomach for the ObamaCare repeal fight at all. He is notoriously nervous about being criticized by the media, having said once that he would never again indulge a government shutdown fight because the media being him up for it, and "there's no lesson to be learned from the second kick of a mule."
But I think he learned the wrong lesson from the first one, which is that you've lost if the media turns against you. Our president-elect is certainly an example of how media criticism is not fatal in politics. Trump is ready to roll on the ObamaCare repeal, as are House Republicans. How they work out the details remains a difficult challenge, but they have the stomach for the fight.
Do Mitch McConnell and his colleagues in the upper chamber? You'd like to think so. McConnell himself says it was the worst piece of legislation passed during the Obama presidency (which it was) and that we need to "go in a different direction."
All right then, Mitch. Let's go. No getting the jitters on a matter this important to the country.
