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Remember when Mitt Romney caught flak for saying he’d “repeal the bad and keep the good” in Obamacare? It looks like Hill Republicans are joining him on that point, if this Politico piece is accurate.
If the law is upheld, Republicans will take to the floor to tear out its most controversial pieces, such as the individual mandate and requirements that employers provide insurance or face fines. If the law is partially or fully overturned they’ll draw up bills to keep the popular, consumer-friendly portions in place — like allowing adult children to remain on parents’ health care plans until age 26, and forcing insurance companies to provide coverage for people with pre-existing conditions. Ripping these provisions from law is too politically risky, Republicans say.
In response, Speaker Boehner put out a statement reiterating that nothing less than full repeal is acceptable, and leadership staff pushed back against the idea that they were preparing to cave. And I believe him! But should Republicans fail to achieve a majority in the Senate, which will prevent anyone who saw the writing on the wall had to see this coming: barring a clean sweep for Republicans in the Senate and the White House, a partial repeal was always the more realistic political end-game. The far likelier result is a situation where a President Romney signs a law that he claims will make Obamacare “more market friendly” as opposed to eliminating the whole thing and starting from scratch.
Phil Klein has gone through this before, step by step, demonstrating that repealing via the reconciliation process (the only option that’s feasible for Republicans) is likely to be difficult for a host of reasons, even if Republicans get to 50 seats plus the vice president:
Reconciliation is likely the only path to repealing Obamacare because the procedural maneuver only requires 51 votes in the Senate, rather than the typical 60. But it’s a complex process that would be impossible to tackle on “day two,” or January 21, 2013.
To start, before a health care reconciliation bill can be written, both chambers of Congress would have to pass a budget resolution. This is something that has never happened before April 1, and that usually occurs in May or June, if at all.
Once that happens, a reconciliation bill would have to go through congressional committees, and pass the House. And that’s just when the fun starts.
Once the bill moves to the Senate, the only provisions that could be repealed through reconciliation would be ones that would reduce the deficit, as determined by the Congressional Budget Office.
This means that Republicans may be able to repeal spending on expanding Medicaid and offering subsidies to individuals to purchase insurance on the new government exchanges, but they’d likely be unable to touch the onerous regulations or tax increases.
That’s a very heavy lift, and it’s why those of you who think anything less than full repeal is unacceptable are very likely to be disappointed. Politico notes that Republicans are already running down how they can reintroduce a host of aspects of Obamacare, including the Medicare prescription drug “donut hole”, in order to avoid any backlash from the populace. (The donut hole, of course, is one of the few sound actuarial aspects of the prescription drug plan, since it translates into a price signal… and don’t get me started on the slacker mandate.) Republicans understand, however, that the base won’t like anything less than full repeal:
But even with those insurance industry reforms — which poll well with the public — Republicans could run into resistance from conservatives, who want to repeal the entire health care law and leave nothing in its place. “I don’t want any vestige of Obamacare left in law,” Rep. Steve King (R-Iowa) said. “Not one particle of DNA.” Before they even put together a bunch of piecemeal health care bills, Republicans would have to overcome their own differences.
This situation is in part a byproduct of the fact that Republicans are more comfortable talking about entitlements than they are talking about the lack of a true marketplace for health care in America. As John Goodman has pointed out, John McCain’s 2008 reforms are just the most recent example of a plan Republicans are afraid to talk about.
Given this, I think a more moderate entitlement solution seems to be a more likely outcome – one which solves some problems with government programs, but leaves the bulk of the health care cost problem unsolved and the failed third party payer system intact. While Republicans are more confident arguing for Medicare and Medicaid-focused reforms today than they have been in the past, they still have a severe lack of knowledge and spine when it comes to making the case for unleashing the competitive marketplace for health insurance… which is a shame, since that’s the best path toward actually bringing down premium costs.