The most ill-advised remark of the fight to pass Obamacare arguably came from then-Speaker Nancy Pelosi. “We have to pass the bill so you can find out what is in it, away from the fog of the controversy," she said.
That “fog of controversy” bit — which is usually dropped from recitations of Pelosi’s quote — reveals what she was actually saying, which was that once the fight over the law’s passage died down, the American people would find there was quite a lot to like in it.
But Republicans correctly smelled blood. It sounded like Pelosi was admitting the Democrats had a plan to jam through passage of a bill whose contents were secret. “We have to pass the bill so you can find out what is in it” became a handy symbol of everything wrong with Obamacare and the process behind its passage. Republicans played Pelosi’s comment over and over again for years. Even though it was misleading, it was a devastating line of attack.
Which is why it’s so strange that Republicans have quite literally adopted “we have to pass the bill so you can find out what is in it” as their health reform strategy.
That is, after all, what repeal and delay is. The plan is Republicans will pass a bill repealing Obamacare, but the repeal will only trigger after a year or two or three. During that interim period, Republicans promise that they will craft and pass their Obamacare replacement — with the looming catastrophe of repeal acting as a forcing mechanism to make sure they don’t shirk their task.
Republicans are planning what Pelosi wasn’t: a legislative strategy in which the details of their health care plan will only come clear — hell, will only even exist — after their bill upending the current system passes.
The strange wrinkle to all this is that repeal and delay is driven by Republicans’ lack of faith in themselves. It’s a legislative device born out of concern that congressional Republicans and the Trump administration will not prioritize replacing Obamacare unless they put a gun to their own heads. It’s an artificial crisis that’s only necessary because Republicans don’t have, and aren’t sure they will ever have, an Obamacare replacement that could simply pass on its own terms.
They don’t want the choice to be between the health system we have and the health system they’re proposing. They want the choice to be between the system they’re proposing and the wreckage of a system they have destroyed.
Conservative health wonks versus repeal and delay
This is no way to legislate, and Republican health care wonks know it. Writing in the journal Health Affairs, Joseph Antos and James Capretta, two conservative health policy experts from the American Enterprise Institute, have published a thorough dismantling of repeal and delay. The strategy, they write, “carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying” and “is unlikely to produce a coherent reform of health care in the United States.”
Antos and Capretta worry, reasonably, that repeal and delay will become repeal and delay and delay and delay — that what will happen, in practice, is Republicans won’t craft a usable replacement plan quickly enough, and so they will simply keep adding time to the clock. Meanwhile, the underlying system will be in chaos; the existing marketplaces will likely collapse as insurers flee the uncertainty created by the GOP’s time bomb:
A process focused solely on reversing the ACA and not on putting something better in its place could easily backfire on the GOP. The political firestorm that would ensue from several million people losing their insurance could be enough to force the GOP to reverse course and take steps to provide some kind of emergency insurance for this population, which could be even more costly than the ACA. The episode could also sour the public on the whole concept of repeal and replace.
Antos and Capretta’s piece goes into much more detail on the technical problems of repeal and delay, and is worth reading in full. But they avoid the fundamental issue animating the whole strategy: Republicans don’t know how to replace Obamacare, and they don’t know how to force themselves to figure it out.
That isn’t to say that individual Republicans, or various conservative think tanks, haven’t sketched out Obamacare repeal plans. They have. But turning those plans into consensus legislation will force Republicans to own their trade-offs, to defend their weak points, to answer to the Congressional Budget Office’s score and to Donald Trump’s Twitter account and to the American Medical Association and, ultimately, to the voters.
Republicans have always been willing to own Obamacare’s repeal, but they have never wanted to own a replacement, or the health care system that will result from its passage. And that hasn’t really changed.
Failing at repeal and delay is much worse than failing at replace
Over at Bloomberg, Steven Dennis relays a conversation with an unnamed Republican senator that shows the way power is sharpening the GOP’s sense of the stakes:
A Republican senator on condition of anonymity said the details of the repeal bill remain very uncertain. Originally, Republicans were planning to simply bring back the bill they put on Obama’s desk last year for his veto.
But that bill was written knowing it wouldn’t become law, and now some Republicans want to make tweaks to soften the blow of repeal.
"Even people who voted for this before are, ‘Wait a minute, wait a minute, we knew that wasn’t going to happen,’" said the senator. "There were no consequences." He said there’s a growing sense among some of his colleagues that they need to have a replacement for Obamacare ready soon "because we’re going to own this."
“There were no consequences.” Now there are. But for Republicans, repeal and delay makes the consequences worse.
Consider the downside of a normal legislative process in which Republicans draft a replacement plan that fails. That’s bad. But, like George W. Bush’s doomed effort to privatize Social Security, it ends. The bill is pulled from the floor, and Republicans move on to other issues, or pass some smaller changes and declare victory.
With repeal and delay, the consequences of failing on a replacement don’t end — the system will be crumbling, and Republicans will have to keep trying to find some form of replacement until they succeed, or until they’re kicked out of office. It makes failure uncontainable, and ensures that replacing Obamacare will dominate Trump’s first term. This is something Trump himself seems increasingly aware of:
Republicans must be careful in that the Dems own the failed ObamaCare disaster, with its poor coverage and massive premium increases......— Donald J. Trump (@realDonaldTrump) January 4, 2017
It’s also worth noting that there’s no reason to believe the Republican Party is particularly close to agreeing on the boundaries of a replacement. While all the Republican plans put forward would leave millions more people uninsured, Kellyanne Conway, one of Trump’s advisers, went on Morning Joe this week and said, “We don’t want anyone who currently has insurance not to have insurance” — a principle that wipes out every Republican repeal plan, including Trump’s own. This doesn’t sound like a party willing to own the consequences of repeal, replace, or delay.
Repeal and delay takes something Republicans already can’t seem to do — agree on an Obamacare replacement — and weaponizes it against themselves. It is a bizarre political strategy, and Democrats are starting to sound downright gleeful about it.
"I think they’re stuck," Senate Minority Leader Chuck Schumer told Bloomberg. "They’re going to regret the day they made this their opening issue."