On Monday night, House Republicans revealed the outlines of their plans to overhaul the overhaul of the health-care system completed by President Barack Obama. The coverage of the GOP proposals suggested that Republicans were keeping a promise to their voters to “repeal and replace” the Affordable Care Act.
"This is Obamacare gone," House Ways and Means Committee Chairman Kevin Brady (R-Texas) told reporters Tuesday morning.
Except, not really.
It's more accurately described as a revision or an altering of the Affordable Care Act. Republicans are keeping the most popular elements of the law — 1) no discrimination by insurance companies against people with preexisting conditions, and 2) children up to 26 years old can stay on their parents' plans — while replacing the less popular elements such as the insurance mandate and subsidies to help people buy coverage.
This is not a full repeal. It is not even a full replacement. It's more of a have-your-cake-and-eat-it-too bill.
The problem with that is that, well, you can't have your cake and eat it, too. The reason Obamacare was able to fund things such as kids younger than 26 staying on their parents' plans was because of the insurance mandate. The less popular stuff paid for the popular stuff. The broccoli is what's good for you; the cheese on top just makes it more palatable. Eating just the cheese isn't the same thing — and it isn't good for you.
How are House Republicans skating past that reality? Easy! By not talking about how much the changes they are making to Obamcare will cost. The legislation has not yet been scored by the Congressional Budget Office — meaning what it would cost and how it would add or subtract from the nation's deficit. And given that the CBO probably won't be able to score the bill until next week at the earliest, it's entirely possible that House Republicans will vote on it before they (or anyone else) knows what the cost will be. And we may not even have a score from the CBO before the legislation moves to the Senate!
McConnell signals GOP ACA bill will go straight to the floor after House passage. "I hope to call it up when we receive it from the House"
— Bridget Bowman (@bridgetbhc) March 7, 2017
What Republicans' inability or unwillingness (or both) to fully repeal all aspects of Obamacare proves is that it's very difficult in politics to take away something people like. Not everyone likes all aspects of Obamacare. But the preexisting-conditions clause? You bet. Same with allowing your kids to stay on your insurance.
To fully repeal Obamacare would mean taking away those things to cut costs. Although some Republican deficit hawks may be keen on that, it would create major political problems for the party heading into the 2018 midterm elections. And most rank-and-file Republicans don't want to fall on their swords for that.
So call what Republicans are doing a “major revision” of Obamacare. Or a “significant overhaul.” But don't call it a “repeal.” It's just not.