Why Republicans Will Vote to Repeal Obamacare, but Not on How to Replace It

Individual party members are refloating their proposals, but leadership isn’t going to push forward on any of them.

WASHINGTON, DC - APRIL 17: U.S. President Barack Obama delivers remarks about Obamacare and the ongoing tensions in Ukraine in the Brady Press Briefing Room at the White House April 17, 2014 in Washington, DC. Secretary of State John Kerry and his counterparts from Russia, Ukraine and the EU issued a joint statement today on the crisis in Ukraine calling for all illegal armed groups to be disarmed, all illegally seized buildings to be returned to their owners, and for all occupied public spaces to be vacated. (Photo by Chip Somodevilla/Getty Images)
National Journal
Sam Baker
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Sam Baker
Nov. 12, 2014, 9:43 a.m.

Re­pub­lic­ans’ pledge to “re­peal and re­place” Obama­care will nev­er die, and yet it is not really alive. It is the un­dead—and it has ris­en again.

With the GOP about to take the Sen­ate’s helm, a hand­ful of law­makers are once again tout­ing plans to re­place the Af­ford­able Care Act. Sen. Marco Ru­bio and Rep. Paul Ry­an are re­portedly work­ing on a new plan, and Sen. Or­rin Hatch, soon to be the chair­man of the power­ful Fin­ance Com­mit­tee, used a USA Today op-ed Wed­nes­day to tout a plan he re­leased in Janu­ary, along with Sens. Tom Coburn and Richard Burr.

Also on Wed­nes­day, Rep. Tom Price plugged an Obama­care al­tern­at­ive he’s been push­ing since 2009, but which has nev­er come up for a vote. In fact, no “re­place” pro­pos­al has ever come up for a vote in the House, des­pite four years of GOP con­trol. The party has nev­er ser­i­ously got­ten be­hind any one pro­pos­al, and that’s un­likely to change now.

Why? It’s an ex­er­cise in fu­til­ity. Pres­id­ent Obama still holds the White House, and he will for an­oth­er two years. He ob­vi­ously is not go­ing to sign off on re­peal­ing his sig­na­ture do­mest­ic achieve­ment, mak­ing any re­place­ment a moot point.

However un­likely it might be, the only tech­nic­ally feas­ible way to re­peal Obama­care is for Re­pub­lic­ans to win the White House in 2016, get to 60 votes in the Sen­ate, keep the House, and de­cide to use all of that polit­ic­al cap­it­al for Obama­care re­peal.

It’s also an ex­er­cise in fu­til­ity that comes with polit­ic­al costs.

If Re­pub­lic­ans ad­op­ted a uni­form re­place­ment plan, they’d have to de­fend polit­ic­ally pain­ful trade-offs—just as Demo­crats have had to do. Noth­ing in health care policy is free. Why would a polit­ic­al party look­ing to ex­pand its power in 2016 want to face those trade-offs head-on, for two years, when it’s im­possible to ac­tu­ally change the dir­ec­tion of fed­er­al health care policy?

The main cri­ti­cism of Obama­care is that it has too many man­dates, too many reg­u­la­tions driv­ing up premi­ums. It’s equally easy to fore­see the lines of at­tack over a pro­pos­al like Hatch’s: It would raise con­sumers’ out-of-pock­et costs (that’s kind of the point), and pop­u­lar pro­vi­sions of Obama­care—such as re­quir­ing in­surers to cov­er people with preex­ist­ing con­di­tions—would go away. (One per­son’s bur­den­some man­dates are an­oth­er per­son’s con­sumer pro­tec­tions.)

Es­pe­cially if Re­pub­lic­ans are ser­i­ous about de­scrib­ing their plan’s trade-offs frankly, they would be open­ing them­selves up to two years of cri­ti­cism des­pite be­ing un­able to pass the thing be­ing cri­ti­cized—and for­cing their party’s pres­id­en­tial can­did­ate to wrestle with those same thorny is­sues.

But the fact that the GOP plans are un­likely to get much trac­tion does not mean they aren’t ser­i­ous pro­pos­als.

Hatch’s plan is reas­on­ably com­pre­hens­ive, es­pe­cially for something that’s just an idea. There are sev­er­al com­pon­ents, but the un­der­ly­ing concept is to have Amer­ic­ans cov­er a big­ger piece of their own health care costs, mak­ing them smarter and more con­scien­tious con­sumers and, ideally, lever­aging that in­to more price-based com­pet­i­tion with­in health care in­dus­tries.

Ry­an has an even big­ger health care plan: Par­tially privat­ize Medi­care and shift Medi­caid away from ded­ic­ated fed­er­al fund­ing, in­to a block-grant pro­gram. And Price has had a health care plan for a long time, which he has re­in­tro­duced in the wake of his party’s midterm gains.

In­side Hatch’s “re­peal and re­place” op-ed was an in­sight in­to what Re­pub­lic­ans are more likely to do re­gard­ing Obama­care in the next two years: “Con­ser­vat­ives should also take ad­vant­age of all op­por­tun­it­ies to re­peal any part of the law and re­place it with bet­ter policies that em­power Amer­ic­ans, not Wash­ing­ton,” he wrote.

There are small, tar­geted pieces of Obama­care where Re­pub­lic­ans might be able to force Obama’s hand. The top pri­or­ity is the law’s tax on med­ic­al devices. There’s already plenty of bi­par­tis­an sup­port for re­peal­ing the tax, and once the the Con­gres­sion­al Budget Of­fice said it would no longer es­tim­ate the total costs of all the law’s pro­vi­sions, taken to­geth­er, it got much easi­er for Obama to give up some of the law’s rev­en­ues.

The em­ploy­er man­date also might be changed or even elim­in­ated, which would be an even big­ger win for the GOP.

Cri­ti­ciz­ing an un­pop­u­lar law and hold­ing bi­par­tis­an votes to ac­tu­ally change it have ob­vi­ous polit­ic­al up­sides and very little risk. As for “re­peal and re­place,” though, don’t hold your breath.

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