The Fix | Analysis
July 18, 2017 at 10:19 AM
Now that they control the levers of power, there's a reason Republicans haven't voted to do the one thing they all agree on: Get rid of Obamacare.
Undoing a major social program that millions rely on without a backup is a political and policy minefield.
And yet, after the GOP attempt to produce a backup imploded (again) Monday night, Senate Majority Leader Mitch McConnell (R-Ky.) indicated the Senate is going to vote to do just that.
As The Washington Post's Sean Sullivan explains, it's more likely that McConnell is daring conservatives to pull the trigger on the health-care market — since they killed the second version of McConnell's bill — than he is making any serious attempt to get rid of Obamacare.
Though he is playing the game: “Passing repeal legislation will allow us to accomplish what we need to do on behalf of our people,” McConnell said on the Senate floor on Tuesday.
Really, McConnell's bet (and it's a safe one) is that even the Obamacare-repeal purists wouldn't dare get rid of the law without a replacement. Doing so runs counterintuitive to basic health-care policy, to the current politics of health care and even the rules of the Senate.
Let's run down why straight repeal of Obamacare would be bad policy and bad politically:
Health-care policy experts say repeal without a replacement could cause the individual insurance market to collapse and for millions of Americans to lose their insurance, literally the opposite of what most Republicans want.
The nonpartisan Congressional Budget Office says that getting rid of Obamacare would leave 32 million more people uninsured by 2025, double premiums and increase the deficit by $137 billion over that time period.
Health-care policy experts say once you start down that path, there's no going back to stabilizing the markets, even if you promise to eventually come up with a replacement plan.
“The longer the period between repeal and replace is, the more the market unravels,” said Gary Claxton, a top analyst at the nonprofit Henry J. Kaiser Family Foundation, when we spoke in January. “And you've blown up the bridge behind you, and you're heading into battle, you can't go backward. You've gotta figure it out, or else things get really bad.”
It helps to think of Obamacare like a stool. The problem with Republicans' repeal effort is that the unpopular parts of the law are the legs holding the more popular parts. If Republicans want to get rid of the individual mandate (and they do), Claxton said “it would blow up the insurance market” because insurers would be required to accept unhealthy (read: expensive) people without also mandating healthy people sign up.
Plus, insurers could just stop selling insurance on the marketplaces if they knew they were eventually going to close. If Republicans haven't figured out a solution by the time the next open enrollment comes around, they'd be in the awkward position of ordering insurers to open their doors for a law they're trying to repeal.
Oh and millions of low-income and disabled Americans could lose their federal-government insurance, Medicaid, because the federal government would stop paying for most of it, leaving states on the hook.
“It's easy to say, 'I want to go down these paths,'" Claxton said, “but once you go down them, they're pretty hard to back their way out of.”
Yes, Republicans have spent the past seven years promising to repeal Obamacare. But Americans sense the danger of undoing the law, which seems to be getting more popular by the minute, without replacing it.
As The Fix's Aaron Blake documented, a March Quinnipiac University poll found 87 percent of people said they wanted Congress to wait to repeal Obamacare until they have a replacement. A March Kaiser Family Foundation poll found just 19 percent of Americans favor repealing Obamacare first, then working to replace it. (A July Kaiser poll found four in 10 want Congress to wait to repeal Obamacare until they have a replacement.)
And a January Washington Post/ABC News poll found that of the 46 percent of Americans who favor repealing Obamacare, most wanted to wait for a replacement.
Already some Senate Republicans are saying they wouldn't vote for a straight repeal. Here's Shelley More Capito (W. Va.), a critic of the bill: "I did not come to Washington to hurt people."
There's one more reason we're in fantasyland here talking about repealing Obamacare: Republicans procedurally can't fully repeal it.
If they try, Democrats will filibuster any repeal effort by requiring 60 votes to move forward, and Republicans only have 52 members.
Republicans have been ducking that scenario by changing only the health-care policy that affects the federal budget. They can do this under a little-known process called reconciliation that requires a majority votes to pass (not 60).
But working under reconciliation means it's an open question if lawmakers can actually undo the biggest parts of Obamacare, like the requirement everyone get insurance and the requirement insurers accept people with preexisting conditions.
And those are the three most intractable problems of repealing Obamacare without a replacement: It would put insurers, Republicans and people who need insurance in a no-win situation.