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Obamacare repeal died in Birmingham

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

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Obamacare repeal might really, actually, truly be dead.

Doug Jones, a Democrat, will soon be Alabama's junior senator. The Republican Senate majority will shrink from 52 to 51.

Republicans have sworn to revisit Obamacare repeal next year, after they pass their tax bill. But Jones's victory may have made it impossible for the GOP to succeed where it has previously failed.

Even with 52 Republican senators, the party had yet to find a plan that could win 50 votes. Now the margin for error is even slimmer.

I surveyed a handful of health care lobbyists well-attuned to congressional Republicans on Tuesday night, once Jones had shocked the political world: Is Obamacare repeal dead?

A couple flatly said "yes." One proffered that they still might try. But the odds seem to be fading, and fast.

Sen. Susan Collins (R-ME) seems to be a "no" on any major Obamacare repeal plan. Sen. Lisa Murkowski (R-AK) has also opposed every bill put forward so far. Sen. John McCain (R-AZ) has shown he's willing to buck his party on health care too. Sen. Rand Paul (R-KY) has refused to back any of the substantial repeal-and-replace bills, including Graham-Cassidy, which was the top candidate to be revived if Republicans took up the issue again.

Now you're subtracting Sen. Luther Strange (R-AL), a reliable vote for Republican leaders, and adding Doug Jones, who has said that while the Affordable Care Act could still be improved, "repeal and replace" is just a political slogan that's "not workable."

Then there is one other thing to consider. Republicans are hoping to pass their tax overhaul in a matter of days.

In that bill, they are planning to repeal Obamacare's individual mandate, which will lead to an estimated 13 million fewer people having insurance and higher premiums, according to the CBO.

But the mandate is also by far the least popular part of Obamacare, the foundation of much of the GOP's opposition to the law. Might they now be content to let repeal go, once they nix the mandate, while leaving the more popular pieces of the law in place?

One lobbyist compared it to Democrats passing Obamacare in 2010. They knew it was unpopular at the time. But they had committed to passing it. It was a "suicide pact" of sorts. Republicans face a similar choice now.

"Looking at the polls and their majorities, do they decide to go after (fill in the blank with the ACA, Medicare, Medicaid, or all of the above) because they know they may never get another chance?" this person said. "It makes no sense, but when does a suicide pact make sense?"

But with the stunning Democratic win in Alabama yesterday, the math might simply be insurmountable. We'll be watching closely, of course, but at long last, Obamacare repeal might really be finished.

Chart of the Day signups 2017 Avalere

Obamacare enrollment has fallen behind. At this point, it's pretty much impossible to see how sign-ups for 2018 could catch up to 2016 or 2017 levels. It would probably require about 3 million people to enroll in the last week.

"That's unlikely," Caroline Pearson at Avalere told me. More here.

Kliff’s Notes

Today's top news

  • “Why This Is Obamacare’s Do-Or-Die Week”: “'This week is the entire ball game,' the Kaiser Family Foundation’s Larry Levitt told TPM. 'A growing enrollment means a healthier risk pool. Declining enrollment means a sicker risk pool. What happens this week will also determine the political narrative about whether the ACA is succeeding or failing.'” —Alice Ollstein, Talking Points Memo
  • “House GOP lawmakers look to delay Cadillac tax, other ACA taxes”: “The Affordable Care Act taxes are all on the U.S. House of Representatives' chopping block. Republicans on the House Ways and Means Committee introduced a bundle of bills on Tuesday to delay the Cadillac tax, employer mandate and other taxes that healthcare industry groups have opposed.” —Susannah Luthi, Modern Healthcare
  • “GOP chairman: CHIP must be attached to next funding bill”: “House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) said Tuesday that funding for a major children's health insurance program needs to be included in a short-term funding bill later this month. The comments from Walden, whose panel oversees the Children's Health Insurance Program (CHIP), add urgency to the push to renew authorization for the program covering 9 million children.” —Peter Sullivan, the Hill

Analysis and longer reads

  • “The health care merger arms race”: “Executives say the deals will save money and improve care. But independent research does not support those claims, and the deals raise questions about whether some companies are gaining excessive power or undermining rivals.” —Bob Herman, Axios
  • “Why Do So Many People Hate Obamacare So Much?”: “The Affordable Care Act, aka Obamacare, has roiled America since the day it was signed into law in 2010. From the start, the public was almost evenly divided between those who supported it and those who opposed it. They still are.” —Julie Rovner, Kaiser Health News
  • “People Don’t Take Their Pills. Only One Thing Seems to Help.”: “When drugs cost them less, patients are more likely to fill prescriptions. Even if people have already purchased drugs, they may skip doses — or split the pills — because of concerns that they won’t be able to afford future refills.” —Austin Frakt, The Incidental Economist

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