Former House Speaker John Boehner says he started “laughing” when he heard the GOP’s plan to swiftly repeal and replace Obamacare. “Republicans never ever agree on health care,” he said in comments first reported by Politico.
And here’s the kicker. “Most of the framework of the Affordable Care Act … that’s going to be there,” Boehner said. He went on to say that he thought everyone covered by Medicaid now would keep their Medicaid coverage.
I’ve seen some react with fury to these comments. Didn’t Boehner hold repeal vote after repeal vote? Didn’t he win back the House in 2010, and hold it thereafter, promising to repeal Obamacare? Didn’t he participate in the government shutdown over Obamacare in 2013?
He did. But to interpret Boehner generously, Obamacare is in a very different place now than it was in 2010, 2012, or even 2013. It’s delivering benefits to about 30 million people. Dozens of states have built budgets around Medicaid dollars flowing in from the federal government. Health systems nationwide have reorganized themselves around its provisions.
It was plausible, if Republicans had won Congress in 2010 and won the presidency in 2012, that repeal and replace — or at least repeal — might happen. At that point, the law’s main insurance expansion hadn’t even begun. But now it has, and so that ship has sailed.
Repeal and replace worked in 2012. It doesn’t work in 2017.
In early January, Yuval Levin, who is deeply plugged in with Republican legislators, wrote a guide to the GOP’s repeal-and-replace strategy. The most interesting point Levin made was how much of it, even today, remains based on plans that Mitt Romney’s team drew up in 2012 — plans drawn up at a very different point in the Affordable Care Act’s life cycle:
The movement to repeal and replace Obamacare was born with 2012 in mind. Obamacare was enacted in 2010 but would not take full effect for four years, and there was a presidential election in the middle of that period. The idea was that if Republicans won in 2012, they would move swiftly to unravel the law before it took effect and then move more slowly and incrementally to enact conservative reforms that would enable a genuine consumer market in coverage for individuals.
The Romney transition team in 2012 developed a detailed strategy for such a two-step approach (including plans for an early repeal-by-reconciliation bill if Republicans took over the Senate). They effectively locked it away in a glass box marked “break in case of Republican president” – and left it unbroken in 2012. But after Trump’s unexpected victory, the first instinct of some Capitol Hill Republicans was to break the glass and get going.
In this telling, Republicans had a message for 2010, and a plan for 2012, and then when Barack Obama won reelection and the Affordable Care Act began delivering benefits, they didn’t revisit either. So now they’re adrift. Their 2012 plan doesn’t make any sense in 2017.
Boehner, who was there when the strategy was developed and also realizes the ways the world has changed, isn’t revealing that repeal and replace was always a con, but he admits it has now become one.
It’s worth noting one other thing Boehner said: “Republicans never ever agree on health care.”
This is a more important point than people realize. Democrats did years and years of work in advance of Obama’s presidency to come to a rough agreement on health care. Republicans haven’t done that work. They know they loathe Obamacare, but they don’t even agree on which parts of it they loathe.
At this point, the House Freedom Caucus has laid down the principle that any replacement must repeal the Medicaid expansion, while a critical number of Republican senators have said that any replacement must keep the Medicaid expansion, or at least its coverage and funding. Both sides would probably say they agree on repealing Obamacare. But they don’t even agree on what that means — which suggests they’re far, far away from agreeing on what a new health system would look like in its place.
And this is where the 2012-versus-2017 distinction becomes so important. A party that doesn’t have a health care plan might be able to repeal Obamacare before it exists — in that case, you’re simply replacing the status quo with the status quo. But it can’t repeal Obamacare after it exists, because that would mean replacing the status quo with complete chaos.