Republicans Need to Rewrite Their Obamacare Script

News from the health-care front.
Is repeal serious, doctor? Photographer: David Paul Morris/Bloomberg

There's plenty of news and almost-news about the Affordable Care Act. Here it is, with the big picture at the end:

  • Republicans are ready to roll out a new "replace" plan. Or, maybe they aren't. Anyway, it's not actually new, because they always go back to the same things. The best take on this remains Jonathan Chait's riff last month: "The Republican Health-Care Plan Is Almost Here, and Always Will Be." In other words, expect Republicans to call to replace Obamacare -- but not to offer concrete legislation to replace it. At least in the House.
  • There's also been talk about what would happen to health care in 2015-2016 if Republicans win control of the Senate. Paul Waldman says House Republicans will be unable to get their act together, so the Senate will be irrelevant, especially given that President Barack Obama would veto anything major. Kevin Drum points out, however, that Republicans probably would attach their repeal bill to must-pass legislation, raising the risks of a veto. In any case, he also says that trusting Senate Democrats to hang tough after a Republican landslide seems rather foolish. My sense is that it all depends on whether Republicans want to reform the law or just want to score points. The latter probably is achievable in many cases, assuming they are willing to horse trade to get what they want. Any symbolic actions wouldn't produce legislation that is signed into law; that would be beside the point.
  • And there's plenty of news on how reform is doing. Bruce Japsen reports that the new exchanges probably have enough sign-ups to function. Remember, that 7 million figure was a projection, not a minimum acceptable number. It's also true that some states still may be in danger - and that "able to function" doesn't necessarily mean thriving.
  • Although it's early, there are some positive signs that the exchanges are introducing competition in the individual market. A competitive (private) market could, theoretically, improve the insurance product and drive down prices.
  • And to get back to the top point: It's hard to make good decisions about health care if your facts are wrong. The Washington Post's fact checker, Glenn Kessler, slams House Speaker John Boehner for claiming that Obamacare has produced a net loss in the number of people covered by insurance. The big problem with the claim is that it's unlikely that many of those whose plans were canceled actually lost insurance (many were simply placed in new plans). The other problem is that only counting exchange sign-ups overlooks young people added to their parents' plans and Americans newly eligible for and enrolled in Medicaid.

The takeaway is that despite its fits and starts, the ACA is the law of the land. Meanwhile, most Republicans are still stuck in fall 2009 or at best fall 2010, and appear to reject new information about what the law actually is doing. That doesn't matter for electoral politics, most likely. But it does make Republicans ill-equipped to govern on this issue -- at least, if governing entails more than symbolic gestures.

This column does not necessarily reflect the opinion of Bloomberg View's editorial board or Bloomberg LP, its owners and investors.