The burgeoning crisis over President Trump’s and former national security adviser Michael Flynn’s connections to Russia makes the already difficult task of repealing and replacing the Affordable Care Act even more confounding for Republicans, who won the White House and both houses of Congress based on unrealistic expectations about an as-yet-unidentified replacement plan.

Consider Paul Ryan’s feel-good meeting with Senate Republicans on Tuesday. The House speaker trekked across the Capitol to reassure senators that lawmakers are making more progress toward repealing the health care law than the media are reporting.
But not everyone was buying it. Sen. Rand Paul (R-Ky.) left before it was over, having heard enough of a conversation that he says centers around keeping Obamacare’s Medicaid expansion intact and creating tax credits that he called a “new entitlement program,” though a Republican in the room rebutted the notion that the topic of Medicaid expansion came up in the Tuesday meeting with Ryan.

But what is too much (too much government, too much spending) for the libertarian-minded senator is wholly insufficient for others, especially for Democrats, eight of whom must cross over to vote for a GOP replacement plan. Ryan’s incessant cheering about a GOP alternative only serves to keep expectations high that there is a plan that does not raise taxes, does not include an individual mandate, does not require high deductibles, does not raise out-of-pocket costs, does not open the floodgates of red ink and does not require cuts in Medicare (which Trump ruled out).


With chaos in the ranks, Republicans now express the wholly unrealistic hope that the White House — a chaos-generating machine — will bring unity and coherence to the reform effort, as Politico reports:

“It’s hard to see how this gets done unless the president says, ‘OK, let’s do it this way,’” said Sen. Lamar Alexander (R-Tenn.), a key committee chairman on Obamacare.
But it’s been awhile since Republicans have heard something substantive from Trump on Obamacare. When the president last weighed in constructively, he was prompted by Paul’s appearance on a cable news show, during which he railed against efforts to repeal the law without a replacement. Trump called up Paul to offer his support. …
“Right now, I would say it’s not that easy to repeal it. I don’t know if it’s a guarantee,” said Rep. Peter King (R-N.Y.). “I don’t know where the White House is. The president has said he’s not going to be kicking people off the program, off the rolls. He’s not going to do that.”
Speaking at the White House alongside Ryan, Trump said simply: “We’re working on Obamacare. It will be very soon.” That did nothing to clear up the ambiguity.

Per usual, Trump is vamping. He has not yet shown support for any specific ideas, and skeptics suspect that he has little — if any — grasp of the specific trade-offs involved. Even if he were to speak up, would any Republican believe that his positions wouldn’t change the next month, or the next day? Does anyone really believe that he would be honest with his base about the impossibility of a plan that is cheaper, better, more flexible and more generous? Waiting for Trump, of all people, to swoop in to solve a problem as complex as replacing Obamacare will leave the GOP with no plan at all, which seems increasingly likely.

When you do look at GOP ideas for a replacement, they do not respond to voters’ complaints about the ACA. “Out-of-pocket spending is one of voters’ top concerns when it comes to health care,” Kaiser Health News explained. “The January 2017 monthly tracking poll from the Kaiser Family Foundation found 67 percent of those polled said their top health priority is ‘lowering the amount individuals pay for health care,’ followed closely by ‘lowering the cost of prescription drugs’ at 61 percent.” Republicans’ plans would make matters worse. “Republicans’ most popular proposals for replacing current individual insurance plans — cutting back on required benefits and giving more people access to tax-preferred health savings accounts — would likely increase out-of-pocket spending for those who use health services (although it would be less expensive for people who are healthy all year long.”


To make matters even dicier, Humana announced Tuesday that it would pull out of the Obamacare exchanges in 2018. (“Humana scaled back its exchange participation to 11 states and 156 counties in 2017, down from 1,351 counties in 19 states the previous year,” the Hill reported. “The withdrawal will have a big impact in Tennessee, where it is the only exchange insurer in several countries. Humana is also one of only two insurers in dozens of counties in states like Mississippi and Georgia.”) Even if the antecedents of Humana’s retreat are traceable to events long before Trump’s arrival, the public will look to Trump to solve the problem. After all, he said he had a “tremendous” plan that we’d all love.

The problem is not limited to Humana, and for that Republicans share much of the blame. Several insurers this month expressed reluctance to commit to the exchanges. “The deadline to submit 2018 exchange plan and premium proposals for regulatory review is fast approaching,” a health-care trade paper reported. “But until health insurers get some answers, they’re stuck. ‘No business that wants to stay in business can make a promise about 2018 under the current situation,’ Ceci Connolly, president and CEO of the Alliance of Community Health Plans, said. ‘It’s just impossible to guess in the total darkness.’ ” Republicans’ indecision paralyzes insurers whose participation in the exchanges is essential for millions of people. (“Aetna, Anthem and Cigna this week all said they can’t decide on future participation until they have an idea of the regulations that will be issued under the next iteration of healthcare reform. That the three are wavering isn’t surprising. They each have lost money from the plans they’ve sold through the insurance exchanges.”)

To recap, Republicans have no idea how to get from here (Obamacare) to there (their mythical health-care nirvana). Trump is of little help, and his credibility and political influence shrink daily. Republicans risk presiding over the acceleration of the meltdown of the exchanges — with an anxious base expecting them to swoop in with the replacement any day now. This has all the makings of a policy and political disaster.