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Question Day: Could Obamacare Be Repealed?

Jonathan Bernstein is a Bloomberg View columnist. He taught political science at the University of Texas at San Antonio and DePauw University and wrote A Plain Blog About Politics.
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Richard Skinner (@richardmskinner -- definitely worth following) asks:

will all '16 GOP candidates back ACA repeal? And how would you expect an actual GOP president to handle it in '17?

I expect repeal of the Affordable Care Act to be the mandatory position for every Republican presidential candidate. Most (perhaps all?) already have had to adopt that stance, and flip-flopping isn't likely to win any votes. There won't be any significant faction within the party willing to push for modifying the law rather than doing away with it. Flat-out repeal stopped being a realistic option (along with the political toll it would extract because of the large number of people who are now relying on its benefits, too much has changed for a simple elimination to make sense). But out in Republican primary-land plenty of people believe the fiction that Obamacare has already collapsed on its own. Primary elections are an unlikely venue for educating rank-and-file voters about reality.

And even though candidates will probably continue to embrace "repeal and replace" rhetoric, don't expect them to roll out real replacement plans. Why? Remember that House Republicans revolted against a Republican bill to extend high-risk pools, even though many in the party had long supported that concept for helping people with pre-existing conditions. The whole concept became tainted when a related idea was included in the ACA. The problem for Republican candidates who want to support a "replace" plan is that the ACA encompasses so many different ideas that it would be almost impossible to put together an alternative plan that doesn't have the same taint. Nor do Republican voters actually care about the substance of the issue, anyway. For them, this isn't about the policy, it's about "government takeovers" and "death panels" and so on. Symbolic problems call for symbolic responses, so expect any Republican presidential candidate who wants to get anywhere to denounce Obamacare and then mumble some vague generalities about patient-centered health care and free markets and the like.

What would a Republican president do? If he (and all the candidates are men) is smart and can get Congress to go along, he would repeal Obamacare and replace it with ... well, pretty much Obamacare, except with Freedom Shoppingplaces instead of exchanges, and with other renamed (but identical) features. The ACA is hardly perfect, but building a replacement would be extremely difficult and politically risky, and there isn't a constituency pushing for it. There could be some changes under a Republican administration -- there's a good chance that subsidies would be reduced, regulations loosened and Obamacare-related taxes cut -- but I wouldn't expect, for example, the individual mandate (I mean the Ronald Reagan Patriotic Participation Incentive) to be eliminated or any other change that might risk catastrophic market failure. No incumbent wants that.

All of the above assumes the ability of a Republican president to move an agenda through Congress. If Democrats win the Senate in 2016 or are aggressive about filibustering legislation, things could get more complicated.

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

To contact the author on this story:
Jonathan Bernstein at jbernstein62@bloomberg.net

To contact the editor on this story:
Max Berley at mberley@bloomberg.net