Sunday, January 8, 2017

The Republican Plan to Repeal and Replace Obamacare Will Do Neither

For years, Republicans have vowed to repeal and replace Obamacare. GOP leadership in Congress held dozens of symbolic votes to repeal the law, teeing up repeal votes shortly after each election cycle so that newly elected members could report to their constituents that they, too, had voted to repeal the law. Last year, President-elect Donald Trump ran as an avowed opponent of the law, promising to strip it from the books and put in place a different plan—something "terrific." After the election delivered unified control of Congress and the White House to the GOP, the party's congressional leadership began to declare that their first act would be to repeal and replace the law, a claim that the administration has repeated.

The repeal and replace of Obamacare, in other words, was—and is—the party's top domestic policy priority. Yet the GOP's current plan to repeal and replace the law would do neither.

Instead, it would further destabilize the already foundering individual health insurance market while setting up a political and policy equilibrium that is likely to make more effective reforms even more difficult.

The current Republican plan, as described by GOP aides to Philip Klein of The Washington Examiner, is to repeal the law now, but leave it in place for a transition period of somewhere between two and four years while they work out a replacement, which in theory would come later this year, and might be passed in pieces rather than as a single bill. It is not a plan to repeal and replace, but a plan to repeal and delay, while promising that a replacement plan will come later.

It is a tactically foolish course of action with numerous potential pitfalls and problems—not least of which is that it does not even repeal all of Obamacare.

To understand why, it helps to understand a bit about Senate procedure. Although Republicans have a majority in the Senate, they lack the 60 votes needed to overcome a filibuster. This means that a repeal bill can only be passed as part of a process known as reconciliation, which allows certain bills to move through the Senate on a simple majority vote. Thanks to a somewhat obscure requirement known as the Byrd Rule, however, reconciliation can only be used on provisions that are directly relevant to the budget. If there is any question about whether a provision passes the Byrd Rule or not, the Senate parliamentarian makes the call.

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