Five years after they first promised an alternative to Obamacare, Republicans still don’t have a plan to replace it.
March has come and gone marking the end of the first year of Obamacare open enrollment. The news is certainly good for the the president, in fact it turns out that Obamacare didn’t destroy the American health care system or liberalism in general after all. Despite the various website problems last fall a last minute surge in enrollment meant that over seven million people ended up enrolling in the Obamacare state and federal health insurance exchanges, just like the non-partisan Congressional Budget Office had predicted all along.
And the result of this is the Republican Party, which has been both predicting and counting on an Obamacare implosion, has been left in a quandary. Unless they are willing to take away the health insurance of around 19 million plus people and give them nothing else in return, they have to come up with their own plan for covering people if Obamacare gets repealed, hence the years-old Republican talking point of “repeal and replace.”
Unfortunately for the GOP, they are running into the very real fact that it’s really hard to replace Obamacare with conservative policies that don’t look like Obamacare. Oh sure you could get rid of Healthcare.gov and replace it with a new website called “The Reagan/Lincoln Health Freedom E-Marketplace” or something, but if you are opposed to Obamacare’s principle of online exchanges you really are going to have a hard time coming up with a viable conservative alternative. This is part of the reason why even though Republicans have been talking about creating an alternative plan since 2009, they really haven’t offered one. It’s basically impossible for the Republicans to create politically viable health care policy that expands coverage without the “three legged stool” of Obamacare. That is the three policy principles of (1) guaranteed issue for folks with pre-existing conditions, (2) an individual mandate so enough healthy people pay into the various plans, and (3) subsidies for low-income folks to be able to afford those plans. Meanwhile Republicans can’t embrace a more radical plan like so called “single payer” because it’s not really conservative at all, and politically they can’t just take away the health care of millions of people with no alternative without enraging millions of voters and powerful interest groups.
And this problem seems to be dawning on a lot of smart Republicans who foolishly assumed Obamacare would collapse under its own weight or something. One unnamed senior GOP Congressional staffer summed this new reality up to Talking Points Memo as:
As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act. … To make something like that work, you have to move in the direction of the ACA. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market.
In the end, this brings it all back to why focusing on repeal was a poor strategy to begin with. Republicans can still shape health care policy to be more to their liking, and can work to reduce subsidies to the poor or cut health care related taxes on the rich, but they aren’t going to radically change the system, at least anytime soon.
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