(Andrew Harrer/Bloomberg)

Since they took control of the House in 2010, Republicans have held more than 60 votes to repeal the Affordable Care Act, in what surely must be a record in American legislative history. So of course they’re going to get right on it as soon as President Trump is inaugurated and can sign the repeal. In fact, Kellyanne Conway said yesterday that Trump is considering “convening a special session” of Congress to repeal the law. “It would be a pretty remarkable move,” she said, which indeed it would be, because Congress will already be in session, but apparently the people in Donald Trump’s inner circle are under the impression that Congress is like the Texas legislature that meets once every two years and has to be called back into special session to pass laws.

But maybe they aren’t going to just repeal it after all. Here’s a report from Alexander Bolton of the Hill:

Congressional Republicans face internal divisions over how far to go in repealing and replacing ObamaCare, one of their top political priorities of the past six years, without disrupting the lives of millions of Americans.

Conservatives like Texas Sen. Ted Cruz (R) and Utah Sen. Mike Lee (R) are pushing for the law to be ripped out “root and branch,” something Senate Majority Leader Mitch McConnell (R-Ky.) has promised to do. …  

But centrist Republicans are worried about millions of people being kicked off insurance rolls if ObamaCare is repealed. They’re hoping to reach compromises with Democrats in hopes of transitioning as smoothly as possible away from the law.

Reach compromises with Democrats? What madness is this?

What’s going on here is that the whole idea of “repealing” the ACA has been something of a scam.

For six years, Republicans have told their constituents that Obamacare is a freedom-crushing demon spit forth from the very fires of hell. And it became their primary vessel of symbolic rebellion against President Obama, the way they could show the folks back home that they’re sticking their middle finger at that usurper in the White House. That’s why they took so many pointless repeal votes. It was a way of saying to their voters, “Hey, don’t forget I still hate Obama.”

Having gone down that road, they now have to follow through — or at least do something that makes it look like they’re following through. The problem is that while “Obamacare” as this vague thing few people understand is quite unpopular, most of the things Obamacare actually does are quite popular. Undoing them in one fell swoop would be an absolutely catastrophic disruption of the American health-care system, and undoing them at all will risk an enormous backlash. That’s what happens when you toss 20 million people off their coverage and make everyone else’s less secure. So what do you do?

The answer is that you say you’re repealing the law, but you don’t actually repeal it. You repeal some parts of it — the unpopular ones — while trying to leave the stuff people like intact. Then you say, “We repealed Obamacare! Woo-hoo!” and hope your constituents don’t notice that you actually didn’t.

Trump has already pointed to two things in the law that he wants to keep: the ability of young people to stay on their parents’ insurance and the ban on insurers denying coverage because of pre-existing conditions. But as Sarah Kliff notes, Trump seems to have no genuine beliefs about health care; his position changes constantly, often in response to whoever he happened to talk to that day.

Since Republicans in Congress have never been able to agree on their “repeal and replace” plan, we don’t know exactly what will happen. But even if they do keep significant parts of the law, what they get rid of will likely cause tremendous disruption and suffering. Just one example: They say they’re keeping the ACA’s ban on pre-existing condition denials, but that’s not really true. First, we’ll be going back to the days when you had to tell the insurance company every time you’ve been to the doctor in the past five or 10 years when you apply for coverage — remember how much fun that made the application process? And if you do have pre-existing conditions, like tens of millions of Americans do, you’ll be shunted off to a “high-risk pool,” which is without a doubt the absolute worst way to cover people with pre-existing conditions.

That’s because it puts all the expensive patients in one pool. Which means that high-risk pool coverage will almost inevitably mean coverage that is incredibly expensive and not as comprehensive as it ought to be. But Republicans have no choice but to do that if they’re going to eliminate the individual mandate (which is one of their top priorities), because with no mandate and a ban on pre-existing condition denials, you’d be able to just wait until you got sick or injured to acquire insurance, and if people were free to do that, the entire insurance market would collapse.

That gives you a sense of how complicated “repeal and replace” is going to be. But it’s important to understand that the decisions about what to keep and what to jettison will be absolutely, 100 percent dictated by politics. That’s because when it comes to health-care policy, Republicans just don’t care. It just isn’t their thing. Apart from a very small number of conservative policy wonks, conservatives’ central idea about health care for as long as we’ve been talking about it as a policy matter, well over half a century now, has been that whatever Democrats are for, they’re against. In periods where it isn’t a pressing issue, they aren’t feverishly coming up with plans, analyzing the problems in the system and worrying about how they can be fixed. It just isn’t their thing. They’d much rather talk about taxes or regulations or the military or any number of other issues. The fact that millions of people still don’t have coverage — even if the ACA dramatically reduced that number — isn’t a problem they think needs to be fixed, or at least not one they’re willing to devote any energy to.

So now, apart from a couple of elements of the ACA (like the individual mandate) that rub them the wrong way, most of them don’t really care what either “repeal” or “replace” looks like in its details. They’re going to pass something, and then call it a victory. But the details are what will have an enormous impact on all of our lives.