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Opinion The GOP’s Obamacare problem, perfectly captured in one awful talking point

President-elect Donald Trump called Obamacare a "complete and total disaster" and said he will be filing a plan to "repeal and replace" it. (Video: The Washington Post)


At approximately 1:30 a.m. this morning, Senate Republicans began their gleeful stampede towards the cliff’s edge otherwise known as Obamacare repeal, voting to approve a measure that will ultimately allow them to kill major parts of the law by a simple majority Senate vote. Make no mistake: quasi-repeal really could become a reality before you know it, and if so, it will be a huge loss for Democrats.

But there are numerous problems for Republicans lurking underneath all the celebratory fervor. The first is that some Republicans are still antsy about voting eventually to repeal big chunks of the law without an agreed upon replacement. The second is that, even if repeal doesn’t take effect for two or three years, the uncertainty about a replacement materializing could unleash chaos in the marketplaces. The third is that the Republican who happens to be the incoming President — Donald Trump — again insisted yesterday that repeal and replace must be simultaneous.

Republicans have apparently settled on a way to spin their way out of these problems — for now, anyway. This spin was previewed by one GOP Senator, who took a widespread GOP talking point and tortured it so brutally that it practically screamed out in pain. Senator Mike Enzi of Wyoming, the chairman of the budget committe, said this:

“The Obamacare bridge is collapsing, and we’re sending in a rescue team. Then we’ll build new bridges to better health care, and finally, when these new bridges are finished, we’ll close the old bridge.”

The careful reader will note that what’s missing from this imagery is what is on the other side of all these bridges. It’s one bridge leading to another bridge, whose destination is only this mystical land known as “better health care.” Interestingly, Enzi’s talking point also signals how Republicans might try to spin marketplace chaos that results from repeal with no guaranteed replacement. The Obamacare bridge is “already” collapsing, meaning that the chaos that GOP repeal unleashes was already in motion. The problem with this is that Republicans are the ones blowing up the old bridge, and spinning that away will be hard to do, given that Republicans have been trying to blow it up for seven years.

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Other Republicans have been using this “bridge” language, too. Recently, both Newt Gingrich and Paul Ryan have offered up versions of it, and in their renderings, too, there is no hint as to what lies on the other side.

The vote in the Senate this morning passed a budget resolution that lays the groundwork for drawing up a bill that would repeal big pieces of the ACA under the “reconciliation” process. Under that, Republicans could repeal the Medicaid expansion and the subsidies that have helped expand coverage to tens of millions, unimpeded by a Democratic filibuster.

But this just means the harder votes are coming. Republicans still have to decide whether they’ll vote on the measure which actually does repeal health coverage for millions with no guarantee of a replacement later. (This would seem to run afoul of what Trump wants; how that will be managed is as yet uncertain.) To be clear, they very well may succeed in doing this. But then, beyond that, they’ll still have to decide on a replacement, and there is simply no way around the likelihood that it will cover far fewer people. As Jonathan Cohn puts it:

The big issue looming over the GOP effort is that most of the Republicans, including Trump, have promised their schemes would provide better coverage than Obamacare does. But in part because conservative schemes typically envision substantially less federal spending, the end result of repeal ― with or without a replacement ― is almost certain to be fewer people with insurance, less comprehensive coverage for those who have it, or some blend of the two.

In other words, at the end of the day, the bridge has to land somewhere. Of course, it’s plausible that it ends up being a Bridge to Nowhere — that no replacement ever materializes, and eventually, after the delay period runs out, Obamcare repeal finally takes hold, and 20 or 30 million end up without coverage. A lot of Republicans would probably see this as a victory. But would Trump be okay with it? I think surely not. Remember, it is crucial to Trump’s political identity and healthy sense of self that he’s the guy who can fix things like Obamcare and that he’s ideologically not like those other cruel Republicans when it comes to using government to expand health care to poor and sick people.

The best case scenario here is that a far less generous replacement does materialize. But in either scenario, Trump ends up being the guy who kicks millions off health insurance. The only question is how many millions. No amount of bridge metaphors can defer that moment forever.


* TRUMP’S PICK FOR DEFENSE SEC IS WARY OF IRAN: James Mattis gets his Senate hearing today, and the Associated Press reports that as the commander of forces in the Mideast, he alarmed the Obama administration with his approach to Iran at times. As the AP notes, former Defense Secretary Leon Panetta wrote in his memoir: “the White House didn’t fully trust Mattis, regarding him as too eager for a military confrontation with Iran.”

Now he’ll be Defense Secretary. One question is what that means for the Iran nuclear deal. Mattis has said it would be hard for the U.S. to walk away from it, so we’ll see.

* BRITISH SPY AT CENTER OF TRUMP CHARGES IS IDENTIFIED: The Post reports the identity of the British fellow who compiled unsubstantiated charges that Russia amassed compromising information on Trump:

The material in the dossier was assembled by a former British intelligence officer, Christopher Steele, whose security and investigations firm was hired to assist a political research firm in Washington that was initially working for Trump’s opponents in the Republican primaries but later offered its services to Democrats….Other officials said U.S. officials had met with Steele…at least twice — once in August and again in mid-October, after Clapper had released a public statement accusing Russia of interfering in the election.

Steele could not be reached, but it seems plausible that he will be reached by reporters one of these days.

* ANOTHER DAY, ANOTHER DISHONEST TRUMP TWEET: Here is this morning’s offering:

Actually, Clapper’s statement explicitly says he called Trump to express dismay about the leaks but that the intelligence community “has not made any judgment that the information in this document is reliable.”

* TRUMP LAWYER DISSEMBLES ON ‘EMOLUMENTS CLAUSE’: Trump’s lawyer claims he won’t violate the Emoluments Clause because it doesn’t apply to “fair value exchanges” like payments by foreign diplomats to his hotels. Michelle Lee dives deep into the issue:

That is technically accurate, but the clause has never been interpreted not to apply to such exchanges, either. That’s because the clause has never actually been interpreted by the courts. This is by no means a clear or settled matter.

As one expert notes, the reason this is untested is that “past presidents have been so careful to avoid even an appearance of violating the clause.” Trump, not so much.

* AMERICANS DON’T KNOW THE ACA EXPANDED COVERAGE: A new NPR poll asks whether people know that the ACA has brought down the uninsured rate, and finds:

About half believed that the number of people without insurance had increased or stayed the same, or said they didn’t know what the law’s effect has been on insurance coverage….Democrats were better informed than Republicans, with 54 percent of Democrats saying the law had reduced the number of people without insurance, compared to 41 percent of Republicans.

This can’t possibly have anything to do with the fact that Republicans have been lying about the ACA pretty much nonstop since even before it passed.

* TRUMP HAS ALREADY PROVED OBAMA RIGHT: E.J. Dionne contrasts Trump’s awful press conference, at which he basically shrugged about meddling in our election, with Obama’s farewell speech, and concludes:

Trump brought home the importance of the central forward-looking theme of President Obama’s moving farewell address….At heart, Obama’s speech was a warning and a plea: an alert about the dangers our democracy confronts and a call for Americans to be active and vigilant in protecting our liberties….Obama never mentioned Trump in this context. Alas for us all, he didn’t have to.

One imagines that Trump will do a lot more in coming weeks and months that will remind us of Obama’s warnings.

* TRUMP VOTERS STILL PRETTY HAPPY WITH THEIR NEW LEADER: Trip Gabriel talks to Trump voters in Iowa and finds that many of them are unfazed by the current controversies swirling around him. Note this:

Many were hazy on specific policy details about how, say, House Republicans were seeking to replace Medicare with a voucher system. These voters feared an outbreak of European-style terrorist attacks by Muslims in the United States, maybe in their own communities. And overwhelmingly, Trump supporters did not want their hard-earned money redistributed to people they regarded as undeserving.

Trump voters aren’t aware that the GOP wants to gut Medicare, but they know Trump will protect them from Muslims and get tough with the lazy poor, so it’s all good.