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
Add to Briefcase
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.

What We're Following See More »
Kelly Picks New Deputy Chief For Policy
2 hours ago

"White House chief of staff John Kelly has tapped Chris Liddell, a senior White House aide and former executive at Microsoft and General Motors, as his deputy." Prior to his appointment, Kelly had just one deputy: "Joe Hagin, who focuses on the day-to-day operations" in the White House. "Up until now, the White House had not named a deputy chief of staff for policy, though several aides, including [DHS Secretary Kirstjen] Nielsen, had informally played that role."

SCOTUS Denies Death Penalty Review
3 hours ago

The Supreme Court on Monday "rejected a plea to undertake a historic reassessment of the constitutionality of the death penalty nationwide. The court denied certiorari in Hidalgo v. Arizona, which challenged the constitutionality of that state’s death penalty statute but also attacked capital punishment generally 'in light of contemporary standards of decency.'" The Court did not act on another case, Evans v. Mississippi, which would have prompted a broader review of the death penalty. "Justice Stephen Breyer, joined by Justices Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan issued a separate statement agreeing that the Hidalgo case should be denied because the record in the case was not fully developed, but hoping a future case would be a better platform for reviewing capital punishment."

Saudi Leader Begins U.S. Visit
3 hours ago

Saudi Crown Prince Mohammad Bin Salman begins his two-week visit to the U.S. this week, meeting with "political and business leaders in Washington, New York, Silicon Valley and elsewhere" in an effort to shore up financial support for his government and rehabilitate its image abroad. "The crown prince employed a similar public relations strategy on a three-day visit to the UK," where he met with "an array of British business and defense leaders." Bin Salman has been widely criticized for his alleged political chicanery in the Gulf, and for Saudi Arabia's devastating air campaign in neighboring Yemen.

Fourth Package Bomb Explodes In Austin
4 hours ago

A fourth package bomb injured two people in Austin on Sunday evening, "which the police chief says was caused by a tripwire and showed 'a different level of skill' than the package bombs used in the three prior attacks." The police are still searching for the perpetrator, and have warned residents to not pick up or approach suspicious packages. Previous explosions, which the police believe are connected, have killed two and wounded several others.

Trump Isn’t Firing Mueller, Lawyer Says
4 hours ago

White House Lawyer Ty Cobb said that President Trump not considering firing special counsel Robert Mueller. Speculation swirled after Trump attacked the investigation on Twitter, and called out Mueller directly for the first time. “In response to media speculation and related questions being posed to the Administration," Cobb said, "...the President is not considering or discussing the firing of the Special Counsel, Robert Mueller." Several members of Congress, "including some top Republicans, warned Trump to not even think about terminating Mueller."


Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.