- The American Conservative - http://www.theamericanconservative.com -

Obamacare Repeal: Back to Square One

Early last month I outlined [1] the problem that Republicans were facing when it came to repealing and replacing Obamacare:

Republicans’ biggest problem is that, unlike the Democrats in 2009 and early 2010, they don’t have a filibuster-proof majority in the Senate. Since Republicans don’t seem inclined to nuke the filibuster itself, they’ll need significant Democratic buy-in to enact a replacement. Specifically, they have just 52 of the needed 60 votes, and the extra votes will not come easily: Democrats are united [2] in defense of the law.

The one workaround is the “reconciliation” process, which is filibuster-proof but can be used only for matters related to the budget. A bill passed through reconciliation can eliminate Obamacare’s taxes and subsidies, in other words, but it can’t touch [3] the law’s mountain of other insurance regulations, including those that dictate plans’ pricing and coverage.

In response, the tactic Republicans have come up with [4] is “repeal-and-delay”: kill the law’s funding through the reconciliation process immediately, but set the changes to take effect two to four years from now. This will force Democrats to the table and give Republicans time to craft a replacement based on the various blueprints that conservative groups have put together.

change_me

A month and a half later, they have a brand new plan, reports the Wall Street Journal (paywall) [5]. It involves a series of “precarious steps.” The first is to pass a reconciliation bill that repeals key chunks of the law and (possibly) creates part of a new system as well. This will “likely include a transition period designed to prevent people losing coverage abruptly.” Executive actions could help ease the transition as well. Further changes will be made a little at a time, through bills that will require 60 votes in the Senate, meaning eight Democrats in support.

So, it’s more or less repeal-and-delay again. As it turns out, there just aren’t that many ways to coerce Democrats to support Obamacare repeal.

The leadership is betting that Republicans won’t dare block the effort, despite being deeply divided on key issues including financial assistance and Medicaid, and that Democrats will get on board with further reforms once a reconciliation bill is enacted.

Those are big bets. It will be incredibly embarrassing if the GOP can’t get a reconciliation bill through, and disastrous for the country if a reconciliation bill destabilizes the market and Democrats and Republicans can’t work together to steady it.

Robert VerBruggen is managing editor of The American Conservative.
Follow @RAVerBruggen [6]

16 Comments (Open | Close)

16 Comments To "Obamacare Repeal: Back to Square One"

#1 Comment By Joe the Plutocrat On February 27, 2017 @ 4:01 pm

“So, it’s more or less repeal-and-delay again. As it turns out, there just aren’t that many ways to coerce Democrats to support Obamacare repeal.” – just a hunch, but how about a BETTER plan? And by better plan, one that addresses the weak points of the ACA, AND beefs up the strong points, you know, something to help ‘working Americans’. At the risk of grabbing low hanging fruit, how about a plan like the one the members of Congress have?

#2 Comment By Jack Harllee On February 27, 2017 @ 4:15 pm

The adults in both parties ought to be working out compromises. The Republicans ought to recognize that the filibuster gives the Democrats some bargaining power and offer significant concessions, that the reconciliation alternative will result in an intolerable mess. The Democrats ought to make constructive proposals of their own. Both sides are putting partisanship ahead of the common good. I do understand that their political survival requires they pander to their respective political bases. Too bad about the country. They may succeed in destabilizing one sixth of the economy and plunging us into recession or worse. And letting millions of ordinary Americans see their coverage degraded or lost outright.

#3 Comment By William Dalton On February 27, 2017 @ 4:17 pm

Doesn’t a bill to repeal all the mandates enforced by tax penalties do away with the entire law? Wasn’t Chief Justice Roberts’ crucial vote to uphold Obamacare based upon it being an exercise of Congress’ power of taxation?

#4 Comment By William Dalton On February 27, 2017 @ 4:21 pm

It should also be remembered that 60 votes are easier to achieve when the opposition actually has to engage in a fillibuster – martial the Senators necessary to hold the floor and continue debate in order to prevent a vote from being taken. Their will be eight Democrats up for reelection in red states who also want other legislation they favor to come to the floor. It certainly worked in years before to get a vote on divisive legislation.

#5 Comment By JonF On February 27, 2017 @ 4:54 pm

Re: Doesn’t a bill to repeal all the mandates enforced by tax penalties do away with the entire law?

No. Reconciliation can only be used for financial and budgetary matters: Taxes and subsidies for sure. They cannot touch the insurance regulations that were passed under the ACA by that process.

#6 Comment By The Autist Formerly Known as “KD” On February 27, 2017 @ 4:56 pm

Why won’t the Democrats just refuse to deal, allow chaos to reign, and then the GOP will own it, and the Dem’s can run on restoring Obamacare?

Especially if the Republicans have some “grand” idea to cut or privatize entitlements.

The normal people I talked to freaking out about Trump (small business types, etc.) were all concerned about losing health care coverage suddenly, not World War T or the plight of undocumented Mexicans.

#7 Comment By Rabiner On February 27, 2017 @ 5:34 pm

What political incentive do Democrats have to assist in the dismantling of something they paid dearly for over the last 8 years and view as an achievement? It isn’t like Republicans have a plan at the moment.

#8 Comment By steveb On February 27, 2017 @ 7:04 pm

This is hysterical:

“This will force Democrats to the table and give Republicans time to craft a replacement based on the various blueprints that conservative groups have put together.”

Because the last 7 years have not been enough time to come up with a better plan? Really?

Please go ahead and repeal it, let’s give the Trump voters exactly what they deserve, no health care. It’s time to stop coddling them, elections have consequences.

#9 Comment By John Fargo On February 27, 2017 @ 7:51 pm

The fillibuster is a very important tool to allow the minority party some control over legislature they feel to be wrong for the country. However, the party in power needs to make the minority actually go through the physical fillibuster, not just a fillibuster threat. I am in my 60s and I would have to be damned committed to my cause to stand for hours with my weakened bladder and dwindling stamina. They’ve made the fillibuster too easy.

#10 Comment By EliteCommInc. On February 27, 2017 @ 11:10 pm

Good grief just end it.

#11 Comment By bacon On February 28, 2017 @ 2:28 am

@ Joe the Plutocrat – I think members of congress have to get their own health insurance. They’re eligible for Obamacare. Of course, starting salary is $174,000, so they’re not exactly waiting in line at the ER.

#12 Comment By ked_x On February 28, 2017 @ 3:14 am

Why would the Democrats help the Republicans after the Republicans repeal large chunks of Obamacare destabilizing it? Think about it, if Obamacare collapses because of Republican actions, the Republicans will own that failure. The Democrats can go to their constituents and say, “Well market based healthcare is a failure. Let’s do government run, single payer healthcare like England as we should have from the start if Obama hadn’t been trying to reach across the aisle.”

#13 Comment By Scott On February 28, 2017 @ 8:37 am

It is rapidly becoming clear that the ACA is the absolutely worst plan. Except for all the others.

#14 Comment By EliteCommInc. On February 28, 2017 @ 9:36 am

Here’s the compromise. The Congress and the last executive handed private industry a boondoggle. It was a proposal that is unconstitutional on its face.

The passage of which was predicted on foundation or foundations layer upon layer of untruths with irrational fear mongering. If there’s any need to fund care for the destitute who are citizens those with proof of birth certificates and whose parents were under the jurisdiction of the US, that means here legally, cap it at ten grand and be done with it. But it’s silly to pretend they can repair what is at best catastrophic costly mess.

Putting the mess to rights first requires wiping the slate to on can operate in clear skies.

A better compromise would be simply to end it. Period. The test is how many are thinking about their re-election bids as opposed to the efficacy of the ACA. A good clue that it should be terminated.

#15 Comment By peanut On February 28, 2017 @ 3:49 pm

“. If there’s any need to fund care for the destitute who are citizens those with proof of birth certificates and whose parents were under the jurisdiction of the US, that means here legally, cap it at ten grand and be done with it”

So, a person comes into the hospital. First, you search him for a birth certificate. Then, you try to get to next of kin, to figure out if they are/were American citizens. By the time you have it all clear, his hospital stay had already cost more than 10K, so you can throw him out, and he dies on the street. Problem solved.

#Winning.

#16 Comment By EliteCommInc. On March 1, 2017 @ 10:36 pm

“So, a person comes into the hospital. First, you search him for a birth certificate. Then, you try to get to next of kin, to figure out if they are/were American citizens.”

I guess if one wants to make up scenarios to fit the advance — uhh, ok. We are talking about signing up for a programs. And for said program, only US citizens qualify.

For emergency services something else is required. If a single visit costs you ten grand, then it costs ten grand. That’s why private wealth insurance, nonfunded by government works so well.

It’s a rather useless example, because for every dollar amount one could make and argument that they need more. Which is why the premise of government funded care doesn’t work. It’s fantasy. If the government actually has a surplus of cash to do so, I guess we could have hat discussion. But in a country in which people have ample resources to manage their own health needs and care. Government funded makes no sense save for a very limited number of people as in destitute and citizens. The federal government is broke. Not just a little broke — broke. Now our international neighbors love that because that is no barrier to government spending. But as someone who is dirt broke poor, what I realized is that my best healthcare comes from me.

I am not sure at what point hospitals decide to no longer provide care, but eventually and many cases immediately, it’s a primary consideration. So your complaint is an attempt at emotional distortion – I am unmoved. Sure hospitals take care of emergencies and they also and people to less expensive facilities, once they are stable.

The real complaint you intend to make is the cost of health care, and government hasn’t made a dent in it. It has guaranteed that care will be paid for, but nothing the ACA does has an impact in lowering costs, or providing better care. In fact, what the insurance companies have done is provide less for more. You can’t get coverage for what is not in your policy.

To be clear citizenship should be a requirement for any health coverage from the federal government. For those on such care – one carries a card as one does a drivers license. The silly argument that the poor can’t get ID is rebutted by the thousands who obtain ID cards for benefits. What I appreciate about liberal arguments is that they are all about indicating what people can’t do, despite the overwhelming data that indicates that they can and do that very thing every day.

Visitors o the US purchase travelers insurance as a precaution against unforeseen events. And people do provide credentials at some further tie . . . nothing like turning the mundane into a catastrophic event demanding immediate attention when in fact, there’s no crisis at all, save the US tax payer is hemorrhaging money.

My 10k number is generous. Too generous, I think it can be cut in half.

In 2013 the highest number of visits to emergency rooms were by those in nursing homes, children under a year of age and the homeless. Private insurance, Medicaid and medicare covered most of the emergency visits. I haven’t a clue why we have an ACA and still maintain coverage for medicare and medicaid. The costs of care vary from state to state. But if 10 grand is a high for a one week stay, the answer is finding out whether the stay is required and why the rate is what it is and then how to lower it. Those are the real issues.

Taking a brief look at who and why hospital visits are made, keeps in the camp that the ACA should be terminated immediately.

Good grief a responsible program would require healthy living. No smoking, no drinking, a healthy diet . . .

But in my read of the ACA, not a word of expectation for government involved health services.