Republicans Really Can Pretend to Repeal Obamacare
The Republicans may have a way out of their "repeal and replace" Obamacare position, which is proving a lot more difficult than they realized. The catch is that their alternative may be even more phony.
It could phonier than the "repeal and rename" strategy I anticipated. For years, I've said that Republicans could simply rename the Affordable Care Act and its various components -- so we might have, for example, "Ronald Reagan Freedom Insurance Choices" instead of the current Obamacare marketplaces.
The reasoning is that while Republicans have hated "Obamacare" as a symbol of the president they can't stand, few of them are particularly upset about the law itself. It's true that a relatively small group of principled libertarian-leaning conservatives don't want government to have anything to do with health care. 1
But most Republican politicians and activists have other priorities -- fighting legal abortion for social conservatives, protecting U.S. interests for foreign-policy conservatives, lowering taxes for economic conservatives. 2
The job of fashioning a working health-care system is incredibly difficult, given the multitude of interest-group demands and market complications involved. This is why Republicans still haven't agreed to a replacement plan after years of promising one. In fact, it's proving difficult for Republicans even to agree on a repeal-and-delay bill, which would leave some or all of Obamacare in place while they figure out what to replace it with.
Congressional scholar Sarah Binder hints that Republicans may wind up trying to get away with something even more cynical. She notes that Republicans are calling the budget resolution currently under debate in the Senate an "Obamacare repeal resolution."
As she points out, a budget resolution by itself doesn't do anything; it merely contains (nonbinding) instructions from Congress to itself to pass future laws, and enables a future "reconciliation" bill. 3 (Molly Reynolds at the Brookings Institution has an excellent explanation of just where this resolution fits in an overall repeal effort.)
Binder suggests, however, that if the eventual repeal bill looks shaky, then Republicans could wind up just celebrating the passage of the budget resolution and calling it a day. "The whole process is complicated, so you start wondering, if they don’t do the reconciliation bill, will anyone know?"
That is, instead of "repeal and delay," Republicans would try "pretend and delay" -- pass a nonbinding resolution and hail it as Mission Accomplished.
Could Donald Trump and congressional Republicans really get away with such a brazen maneuver?
I don't see why not.
Democrats wouldn't complain much; they care more about preserving the substance of the policy than about drawing attention to the hypocrisy of a symbolic move. And most Republican voters care more about the symbolism. To avoid getting mired in repealing and replacing a complicated law in a complicated policy area, Trump and the Republicans in Congress could opt for ways to make the issue go away -- not unlike slapping your name on a building but not owning it.
The pivotal factor would be if the Republican-aligned media such as Fox News and conservative talk radio and websites accept the deception.
My guess is they would play along for now, just as they tended to play along with President George W. Bush on various violations of conservative orthodoxy in his first term. Picking a fight with a new Republican president would be risky for those who care only about ratings, and most of those who care about policy have higher priorities, such as the confirmation fight for Trump's first Supreme Court nominee.
As it turns out, one disadvantage in building popular support for the Affordable Care Act -- that consumers don't generally see anything named the "Affordable Care Act" or "Obamacare" when they use the health-care system -- could turn out to be a real advantage when it comes to pretending to repeal and replace it.
Expanded Medicaid, for example, will continue to just be called (plain, old) Medicaid. It would be easy for everyone to believe Obamacare never existed.
Opting for the pretend solution wouldn't end debates and decisions on health care, of course. Republicans would still want to cut some of the taxes involved, and might try to make all sorts of other changes, which Democrats would try to prevent. It would be, that is, politics as usual.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
An even smaller group of conservative health-care experts believes it can fashion a better, more market-based system. But most of these experts know that many of their ideas, such as severing insurance from employment, would be unpopular. And policy experts hold little sway over Republican politicians in most areas.
The Affordable Care Act includes substantial progressive taxes, which economic conservatives want to eliminate. But those conservatives have repeatedly shown they don't particularly care if federal deficits increase from tax cuts.
Reconciliation bills need only a simple majority in the Senate, as opposed to normal bills, which can be filibustered (and would then need 60 votes). A normal budget resolution also sets spending levels for appropriations bills. This particular budget resolution, however, is intended mainly as a vehicle for Obamacare repeal, and the fiscal year it covers is already almost half over; Congress has no intention of passing a series of half-year appropriations bills under this budget resolution.
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