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A very simple theory for why the House is struggling to repeal Obamacare

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There are plenty of reasons Republicans can offer right now about why they can't repeal Obamacare, such as the peculiar Senate rules that govern reconciliation, or the difficulty of drafting the actual legislation.

Byron York, however, offers today what is arguably the Occam's razor theory of Obamacare repeal, the simplest explanation of why Republicans haven't overturned President Obama's health care law.

They don't want to.

Writing in today's Washington Examiner, York quotes a Republican legislator who tells him: "I thought we campaigned on repealing it. Now that it's our turn, I'm finding there's about 50 people who really don't want to repeal Obamacare. They want to keep it."

There are definitely some Republicans who do want to repeal Obamacare. Freedom Caucus leaders like Reps. Mark Meadows (R-NC) and Jim Jordan (R-OH) have been quite clear that they want to dismantle key Obamacare programs. Again and again, they've said that the law's preexisting condition protections and essential health benefits mandates have to go.

When I think about the goals of the Freedom Caucus, it feels transparent and obvious: They want to deregulate the individual insurance market. Whether you agree with those goals or not, you can't fault them for being secretive about their intentions.

But when you look at the moderates who oppose the American Health Care Act, it's never been quite clear what exactly they want to change about the Affordable Care Act. They've certainly been clear that they don't want to get rid of the protections for people with preexisting conditions, for example. Just look at what Deputy House Whip Patrick McHenry (R-NC) told Bloomberg's Sahil Kapur a few weeks ago:

There are a lot of provisions that I've campaigned on for four election cycles that are part of the law now that I want to preserve. So if you look at a cross section of the conference, they have similar positions about similar provisions — preexisting conditions, guarantee issue and medical underwriting are components of that.

The core provisions here are really important protections.

The main faction of legislators holding up the Obamacare repeal process is the Tuesday Group, a loose coalition of more moderate Republicans. They have made clear that they do not want many people to lose coverage. When they clarify their position, it is usually to talk about the parts of the health care law they don't want to touch. This example from New Jersey Rep. Rodney Frelinghuysen, first reported by my colleague Dylan Scott, is a good example:

In addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues.

Moderate Republicans have not made clear at all what they actually want an Obamacare repeal bill to look like. Maybe that's because they're still working through their positions. Or maybe it's because, as York suggests, Obamacare repeal just doesn't look like a good deal to them right now. About 20 million Americans rely on the law for coverage. It has gotten more popular just as Republicans work to repeal it.

Chart of the Day

Health Affairs

Here's a chart that surprised me. For the past decade, the number of imaging tests that doctors order — things like X-rays and CAT scans — increased rapidly. But a team of researchers now find that there's been a decline in recent years, since about 2009 or so. The change happened, they find, after the government changed the medical coding system for these tests. Read more here.

Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

Top news

  • "Republicans won't vote on ObamaCare replacement bill this week": "House Majority Leader Kevin McCarthy (R-Calif.) confirmed Thursday night that GOP leadership will not bring a revised ObamaCare replacement bill to the floor this week.White House officials had been pushing for a vote by President Trump's 100th day in office on Saturday, but it was clear Thursday night that the majority vote needed to pass the healthcare bill had not materialized.” —Scott Wong, the Hill
  • "Pre-existing conditions drive moderates' concern over repeal bill": “House Republican leaders hoped that the House Freedom Caucus’s endorsement of the latest Obamacare repeal bill would light a fire under enough moderates to get their whip count to the 216 votes needed to pass the measure. Instead, the holdouts are digging in, saying that the latest changes only moved the bill to the right and could put more Americans at risk of losing their health insurance.” —Jennifer Haberkorn, Politico
  • "Kasich comes out against GOP's Obamacare repeal bill: 'I'm not for it'": “Ohio Gov. John Kasich said Friday that he's opposed to the House Republican plan to repeal and replace Obamacare, and said the GOP should be working with Democrats as they work to change federal healthcare policy. Kasich, the Republican governor who expanded the Medicaid program under Obamacare, said Republicans were ‘jamming something through that's going to take health coverage away from millions of people.’” —Kimberly Leonard, Washington Examiner
  • "Trump names anti-abortion leader Yoest to top HHS post": “President Donald Trump on Friday said he would name one of the most prominent anti-abortion activists in the country to a top communications post at HHS. Charmaine Yoest, tapped to be assistant secretary of public affairs, is a senior fellow at American Values. She is the former president of Americans United for Life, which has been instrumental in advancing anti-abortion legislation at the state level to restrict access to the procedure.” —Rachana Pradhan, Politico

Longer reads and analysis

  • "Trump’s Latest Tweets Are Bad News for Puerto Rico’s Health Care Crisis": “The territory’s troubled Medicaid system was one of the elements of its government that was not touched by legislation passed last year by Congress to help Puerto Rico dig itself out of an extraordinary hole of debt. The legislation granted the territory relief from creditors’ lawsuits, which expires at the end of this month. It also created an avenue for the territory to file for bankruptcy, something many expect it could be forced to do.” —Rob Garver, Fiscal Times

"Super-sized drug price hikes are gone. The profits aren't": “First-quarter reports show many of the largest pharmaceutical companies increased their profits compared with the same period last year. Sales of some drugs lagged, but companies still hiked list prices by high single digits — well above general inflation.” —Bob Herman, Axios