Health Care

Maybe Republicans Don't Want to Kill Obamacare After All

By putting off a decision for three years, they are improving the chances the law will survive.

Feeling her pain.

Photographer: Joe Raedle/Getty Images

Commentators who are experts on health-insurance reform have argued that the current Republican "repeal and delay" plan for Obamacare is a mistake, if not a disaster. This group includes Affordable Care Act opponents, such as my View colleague Megan McArdle and the Washington Examiner's Philip Klein, as well as supporters of the law such as Vox's Sarah Kliff and HuffPost's Jonathan Cohn and Jeffrey Young.

Republicans tentatively plan to hold a "repeal" vote soon after the new Congress convenes. But they have put off the effective date for carrying it out for up to three years, so they can come up with a workable replacement plan they can all agree on.

The problems with the slow-motion "repeal and replace" plan are in part technical, as the experts describe.

But the hurdles are also political. Republicans seem to believe that setting a concrete date for when the Affordable Care Act would just disappear would pressure Democrats into some bipartisan deal in 2020. Republicans might need the votes, since it's unclear they will ever come up with something their conference can agree on in both chambers of Congress (and in any case they'll need the cover if they retain the parts of the law that Americans really like).

But it's hard to see what incentives the Democrats would have to make such a deal, given the possibility the Republicans can't pass a replacement on their own. If that happens, Democrats will likely just support extending the deadline indefinitely, leaving Republicans no better off than they are now. If anything, Republicans might have fewer votes in Congress, and perhaps a less popular president, if they wait until after the 2018 midterms. 1

Republicans may be underappreciating the extent to which they will now inherit the blame for every glitch and problem in everyone's health insurance, regardless of whether it has anything to do with Obamacare. 2

This would probably be true even if Republicans did nothing. But a ballyhooed "repeal" vote could be an even greater risk for them, since we can assume the Tweeter-in-Chief will immediately and repeatedly brag about how he has already fulfilled his campaign promise to replace Obamacare with something terrific. 

Remember, a hallmark of the Affordable Care Act is that there is nothing called "Affordable Care Act" or "Obamacare" for people to interact with. Most people who have added coverage under the law benefited from expanded Medicaid; the rest are covered by regular private insurance companies purchased through state-based exchanges such as "Kynect" in Kentucky and "Covered California." Even those who use the healthcare.gov portal don't see the words Obamacare or Affordable Care Act. 

So once Obamacare has been "repealed," many citizens will simply believe it's gone even if it remains fully in force, since they don't realize they themselves are involved with it.

All this will make it harder to build momentum for a consensus Republican health-care plan. Few Republican constituencies and few Republican politicians care deeply enough about the subject in the first place; certainly health care is a concern for many, but not an organizing one lifting the issue to a top priority. This is probably why, years after promising that a real replacement plan would be ready soon, Republicans find themselves without one. 3

I still think the Republicans' best plan would be to simply rename the whole thing and pretend they've "replaced" Obamacare with a new, market-based solution. If they do that, there would still be plenty that Republicans could do over time to modify every component of Obamacare in directions they prefer. And they would no longer have the burden of constructing an entirely new system. 

But if they really want to try to tear the system down and rebuild it, then there is never going to be a better time than as soon as possible. 

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

  1. The president's party almost always loses seats in midterms. Of course, there's no way to know if that will happen to the Republicans and Donald Trump in 2018.

  2. This dynamic is one reason Obamacare remains unpopular. People know that Democrats designed a new health-care system, so they tend to blame "Obamacare" for any troubles they have.

  3. Yes, the Republicans have plenty of health-care reform ideas, and some of them are fairly well developed. But none of them is ready to be introduced as comprehensive legislation, and various Republican factions are far from agreement on the best approach. 

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

To contact the editor responsible for this story:
Katy Roberts at kroberts29@bloomberg.net

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