The two things that made me think Obamacare repeal isn’t a sure thing — One month ago, as the surprise of the election wore off and the reality of a Republican-controlled Washington sunk in, I would have predicted that Obamacare repeal was a foregone conclusion.
Republicans have spent six years promising to repeal the Affordable Care Act. They have maintained incredible party unity on the issue, not wavering even as millions of people gained coverage. Legislators quickly moved to make it their first agenda item in Congress. The matter felt settled.
Except today, a month later, it doesn’t feel settled at all. There are two key developments that have reshaped my thinking about Affordable Care Act repeal:
- Republicans are struggling to maintain party unity on leadership’s preferred “repeal and delay” strategy. There are at least seven Republican senators who have expressed reservations about the idea of repealing Obamacare and setting a deadline a few years in the future to come up with a replacement. Three defections from the 52-member Republican Senate caucus would be enough to sink a repeal-and-delay bill, which would need 50 votes to pass. I expect this list of seven to grow, as there are still dozens of senators who haven’t voiced an opinion either way on the matter.
- Republican governors are trying to slow down Obamacare repeal. Governors who expanded Medicaid are starting to voice concern about the effect of repeal in their states. This includes Republican Govs. John Kasich of Ohio and Rick Snyder of Michigan. “Our hospitals needed Medicaid expansion,” Kasich told reporters last week. “It has worked very well in this state.”
The Republican Party is fracturing around Obamacare in ways we haven’t seen before. This is happening for a simple reason: It’s really, really hard to end health insurance benefits for 20 million Americans, especially when you don’t have a plan for what comes next. I still think repeal is the most likely outcome of this debate — it just doesn’t seen nearly as certain possibility as it did a month ago.
I’ve spent seven years covering the Affordable Care Act, and right now I honestly don’t know what will happen next. It is reminiscent of the early days of Democrats’ health care debate, when we legitimately did not know if the party would succeed in passing the largest expansion of coverage in decades.
We don’t know, for example, how seriously Republican senators oppose repeal and delay — whether these are some initial protests that will die down, or if they are serious about voting against the approach. We don’t know if Obamacare repeal will face protest from the right-wing House Freedom Caucus, which doesn’t like the idea of putting off Obamacare repeal at all.
There’s a lot of uncertainty right now — and a lot of developments each day that could affect Obamacare’s future. That’s why we here at Vox are going to start producing a regular roundup of the most important developments. With that, let’s get to the news.
One tweet that perfectly captures Republicans’ Obamacare dilemma — Earlier today, Bloomberg reporter Sahil Kapur tweeted something that shows how much space currently exists between Republicans’ replacement plans and their policy desires.
Sen. Shelley Moore Capito (R-WV) tells me she wants an Obamacare replacement to cover MORE people than Obamacare. https://t.co/zEF4ORMfi3— Sahil Kapur (@sahilkapur) January 9, 2017
Expanding health benefits is popular, but it’s also expensive. And most of the Republican Obamacare replacement plans I’ve read end up doing the opposite of what Sen. Moore Capito suggests. They tend to spend less money on expanding coverage, and cover millions fewer than the Affordable Care Act currently does.
You’re going to see this tension come up in different forms throughout the health care debate between coverage and costs. As Ezra Klein writes, for example, Republicans have said they want to fix Obamacare deductibles and high out-of-pocket costs — making coverage more robust — but in actuality offer plans that would cover fewer benefits. Read more about that here.
Sure looks like North Carolina will get to expand Medicaid — As one of his first acts in office, newly elected North Carolina Gov. Roy Cooper sent the Obama administration an application to expand Medicaid. The Obama administration, unsurprisingly, is ready to act fast on the state’s request. “We will process the governor’s proposal as expeditiously as possible,” Health and Human Services Secretary Sylvia Mathews Burwell said Monday during a talk at the National Press Club.
Democrats plan all-night “talk-a-thon” on Obamacare before early repeal vote — This event will not stop Republicans from moving forward on repeal efforts. But given the attention and energy that Democrats’ gun control sit-in generated a few months ago, the party is likely looking to get a few fiery speeches into circulation defending the Affordable Care Act and lambasting Republicans’ efforts to repeal it.
Kliff’s notes: today’s three key health care reads
- “The Health Care Plan Trump Voters Really Want”: “If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs.”
- Connecticut Gov. Dannel Malloy makes the case against repeal and delay: “Repeal without a corresponding replacement now will mean no one will write insurance policies for the next enrollment year.”
- Obamacare repeal’s doomsday scenario: “Hospital and health plan leaders talk in almost apocalyptic terms about what might lie ahead if Republicans abolish Obamacare without a blueprint for its replacement.”