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Opinion The battle over Obamacare repeal starts now. Are Republicans going wobbly?

President Obama and Vice President-elect Mike Pence each meet with lawmakers from their parties, Jan. 4, to discuss plans for the Affordable Care Act. (Video: Sarah Parnass/The Washington Post, Photo: Matt McClain/The Washington Post)
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Today Republicans are set to huddle on Capitol Hill with incoming Vice President Mike Pence to talk about their strategy for repeal, or repeal-and-delay, or repeal-and-replace, or repeal-and-maybe-replace, or repeal-and-pretend-to-want-to-replace — whatever you want to call it, Obamacare repeal is very likely to happen.

Are Republicans going wobbly? I doubt it will mean that much in the long run. But some reports this morning are hinting at it.

To be sure, Republicans are entering into a totally new phase — the great and glorious moment of liberation and catharsis they have long yearned for is upon them. But all is not bliss. For years, they could vote for repeal, secure in the knowledge that they would never have to deal with the consequences of it actually happening. Republicans could rail away without worrying that their own constituents would lose health coverage — allowing them to say they supported the ACA’s popular provisions while not explaining how they’d retain those things under a (non-existent) GOP replacement.

Trump opponents find an ally: Republican incompetence

But, now that it is very likely to happen, Republicans are finding repeal isn’t so awesome, after all. CNN reports today that some Republicans are now publicly worrying about the Republican plan to repeal the law on a delayed schedule that would theoretically give them time to come up with a replacement later, and they’re pumping the brakes a bit:

Sen. John McCain told reporters…that he supports taking a slower approach to repealing the law, saying he is “always worried about something that took a long time in the making and we’ve got to concentrate our efforts to making sure that we do it right so that nobody’s left out.”
Newt Gingrich, the former Republican House Speaker and a close ally of President-elect Donald Trump, told CNN that a big risk for Republicans is getting blamed for taking away people’s health coverage. “Number one thing (Republicans) have to avoid is putting themselves in a position where Democrats can frighten people — that somehow, they won’t have access to health care because of Republicans,” Gingrich said.
Gingrich stressed that before Republicans send a bill repealing Obamacare to Trump’s desk, the party must make real progress on a replacement plan. “They have to have bridges to give people a sense of comfort that they’re not going to be abandoned,” he said.
GOP Sen. Rand Paul cited potential insurance market problems if the law isn’t replaced when it is repealed. “If Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of Obamacare,” he said in an op-ed Tuesday.

How Republicans can avoid further screw-ups

Note that Gingrich’s primary concern is that Republicans will be put in the optical position of taking the blame for millions losing coverage — which, of course, would actually happen if Republicans do repeal the law without replacing it. So Republicans must create a way to make those who would lose coverage believe they won’t lose it later, with some sort of “bridge” that will keep them covered until that long-promised GOP replacement finally materializes.

Democrats are meeting with Obama about how to defend the Affordable Care Act, just as the GOP is gearing up to debate getting rid of the 2010 health-care law. (Video: The Washington Post)

Paul Ryan has also employed similar “bridge” rhetoric, claiming: “There will be a transition and a bridge so that no one is left out in the cold, so that no one is worse off.” It’s hard to know whether Ryan means that “no one will be worse off” during the delay and transition, i.e., before repeal actually takes effect, or whether he means this will be the case under the GOP replacement.

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I suspect it’s the former. Indeed, it’s plausible that all of these expressions of caution and doubt from Republicans mostly constitute a bait and switch. Republicans are signaling great worry about the fate of the law’s beneficiaries, and signaling to the Very Serious People in Washington that they, too, are Very Serious about health care policy, to give themselves cover to repeal the law without any agreed-upon replacement, which they’ll do oh-so-reluctantly, while insisting, we Republicans had better prove that we’re serious about replacing it later, dammit! Maybe that’s too cynical. Maybe some Republicans will prove me wrong by opposing repeal without an agreed-upon replacement. They will have the chance to do this very soon. So we’ll see. And maybe some Republicans who do vote for repeal now sincerely intend to produce a replacement that doesn’t leave a lot of people without coverage. That will be answered soon enough, too.

But that aside, all this maneuvering does signal one thing: The politics of this are such that some Republicans, at least, believe they must be seen as wanting to produce a replacement that somehow covers all of the ACA’s current beneficiaries. (Never mind whether that replacement would do so nearly as generously even if it did materialize.) Numerous Republicans are now saying that under the eventual GOP replacement, there will be no backsliding in the number covered. Ryan and Gingrich both suggested that above. And as Jonathan Cohn reports, senior Trump transition advisers have been signaling something similar.

But whatever Republicans are saying now, at some point, having repealed the law on a delay, they will inevitably collide with the question of whether they actually meant what they said. They will have to decide how, or whether, their replacement plan actually will cover all those people. And those people are Republicans’ own constituents: More than 20 GOP senators represent states that have opted into the Medicaid expansion. Some of the big states Donald Trump won — and are represented by GOP senators — have huge numbers of people benefiting from ACA subsidies.

It is all but certain that the replacement Republicans do coalesce behind — if that even happens at all — will result in many of those people losing insurance. But here’s the point: That is a political eventuality they can’t outrun forever.


* REPLACING ACA CREATES HUGE PROBLEM FOR GOP: NBC News reports that Republicans are grappling with a big obstacle to their hopes of creating a replacement for the ACA:

Republicans, who generally dislike any tax increase, are finding that the increase in taxes used to pay for the ACA, including the Medicaid expansion and the subsidies for lower-income people to buy insurance, has raised a significant amount of money to pay for health care. A complete repeal of all tax increases would leave little money to pay for a GOP alternative.

Yes, it turns out tax increases generate money to pay for stuff! This is another reason why there are good reasons for pessimism that a consensus replacement will ever materialize.

* DEMOCRATS PLOT TO DEFEND THE ACA: Politico reports that Obama and Democrats are set to meet today to discuss how to defend the law:

Democrats recognize that there’s little they can do to prevent the repeal…But they’re preparing for a messaging battle to make Republicans feel the squeeze as they upend programs that have helped cover millions of previously uninsured Americans. They’re also vowing to muck-up the repeal process in any way they can, vowing to make life difficult for Republicans trying to come up with a replacement plan to swap out with Obamacare.

One big question will be whether Dems draw a hard line by only participating in a replacement that doesn’t represent a huge step backwards, as Chuck Schumer has promised they will do.

* A WAR WITHIN THE TRUMP ADMINISTRATION OVER TRADE: The New York Times reports that Trump’s new pick for U.S. Trade Representative, Robert Lighthizer, is a big advocate of protectionist policies. But:

There is…an ideological divide between the people Mr. Trump has named to oversee trade policy and his broader circle of advisers, which is populated by longstanding trade advocates like Gary D. Cohn, the president of Goldman Sachs, who will lead the National Economic Council; Rex W. Tillerson, the chief executive of Exxon Mobil, tapped for secretary of state; and Gov. Terry Branstad of Iowa, Mr. Trump’s choice for ambassador to China.

As the Times notes, there will likely be an internal administration battle over how or whether to renegotiate NAFTA. But remember: such a re-write might also favor large corporations.

* SENATORS TO PUSH FOR SENTENCING REFORM: Politico reports that a handful of Republican and Dem senators (including Minority Whip Dick Durbin) hope to revive the push for criminal justice reforms, such as a reduction in mandatory minimum sentences, in the Trump era:

Senate Judiciary Committee chair Chuck Grassley plans to take up a bill to revamp U.S. sentencing laws and reform prisons soon after his panel clears the high-profile nominations from Donald Trump….The chief authors of the criminal justice overhaul…will continue to try to drum up more support among senators, while “educating” the Trump administration about their bill’s merits.

It’s hard to say how Trump might react — “law and order” conservatives oppose the push, and Trump ran as one of them — but if he were open to it, this could prove a rare bright spot.

* TRUMP CLAIMS INTEL MEETING WAS DELAYED — BUT WAS IT? Trump tweeted that his scheduled intel briefing on Russian meddling in the election was “delayed,” calling it “very strange.” But the Post reports:

A U.S. official disputed that there had been any delay in delivering the briefing that Trump requested on Russia, saying that high-level U.S. intelligence officials are scheduled to meet with the president-elect in New York on Friday.

Good to see that Trump is in command of the details on something as important as informing himself on the question of whether our democracy was compromised.


That intel briefing on Friday, at which top officials are expected to lay out the evidence of Russian interference to Trump, is going to be really something, should Trump throw Assange’s claims back in their faces.