Obamacare repeal isn’t dead as long as Republicans control Congress

The latest Republican bill to repeal the Affordable Care Act died in the Senate on Tuesday. But the party’s effort to repeal the law remains very much alive.

As long as the GOP controls Congress, they’ll keep trying.

“We are going to fulfill our promise to repeal and replace,” Sen. Lindsey Graham (R-SC) promised at a press conference announcing there would be no vote on his proposal with Sen. Bill Cassidy (R-LA).

Already, Republicans are discussing how to overcome procedural hurdles to getting it done with just a simple majority, Politico reports. One aide said they’ve got their eye on a must-pass budget proposal. “It’s not like we couldn’t slip it in anyway,” the aide told Politico.

The last few bills Republicans have tried, and failed, to pass were wildly unpopular, rejected by health care groups and scored poorly by the Congressional Budget Office. Still, the party believes that it must make good on its seven-year promise to repeal the law. Republican voters say it’s a priority, and donors do too.

Republican legislators want to vote for a bill to repeal Obamacare

Consider, for a moment, all the things that didn’t deter Republican senators from continuing to pursue Obamacare repeal.

Republicans didn’t stop working on Obamacare repeal after House Speaker Paul Ryan declared it “the law of the land,” when the House couldn’t muster enough votes for a bill offered in March.

Republicans didn’t stop working on Obamacare repeal when they learned that the House bill, the American Health Care Act, would cause 22 million Americans to lose coverage.

Republicans didn’t stop working on Obamacare repeal this past summer, after the Senate rejected three separate Obamacare repeal bills within the course of three days.

They didn’t stop working on repeal as patient group after patient group came out in opposition to their bills — or after all 50 Medicaid directors, including 33 who serve Republican governors, came out against the latest bill, Graham-Cassidy.

Republicans have continued to pursue Obamacare repeal despite opposition and poor polling numbers. Rank-and-file members have continued to agitate for Obamacare repeal even after leadership seemed to want to put it to rest.

Failed votes haven’t dampened the enthusiasm for Obamacare repeal in the past. So far, we’ve typically watched a cycle where Republicans take a month or two to regroup, and then begin to work anew on a slightly different plan. There is little reason to think this failed vote won’t lead to the same outcome.

The Republican base still wants to see the Affordable Care Act turned back

Republicans have good political reasons to pursue repeal, even if their policy proposals aren’t holding up well.

Last week, the Kaiser Family Foundation released a poll that asked 1,179 adults what they thought Congress ought to focus on for the remainder of 2017.

Seventy-one percent of those who identified as Republican said it was “extremely” or “very” important that Congress continue to focus on repealing the Affordable Care Act.

When the question was phrased as a choice — should Congress work to stabilize the Affordable Care Act or repeal it? — the results looked pretty similar. Two-thirds of Republicans would prefer to focus on getting rid of Obamacare rather than fixing it.

The individual Obamacare repeal bills tend to poll poorly; a minority of Republicans supported the Graham-Cassidy plan. But more generally, the idea of repealing Obamacare still has valence among conservative voters.

This is something I understood a bit better after my reporting last fall in Kentucky, talking to Obamacare enrollees who voted for President Trump. Many of them did have real problems with their coverage. They were especially frustrated with how high their deductibles had grown, regularly upward of $2,000 or $3,000.

The idea of “Obamacare repeal,” in their minds, represented a plan to fix those problems. None of the Republican plans offered so far actually deliver on that kind of fix. They would make the problem of high out-of-pocket spending significantly worse. But the idea that there is something broken in the health care system, and Republican legislators ought to fix it, seems to be at the heart of the desire for the party to keep on working towards repeal.

Obamacare repeal is still a live possibility

Republicans control Congress for another year, at minimum. They have different vehicles they could use to pursue another push for Obamacare repeal, must-pass legislation that could become a new way forward.

There are generally 45 or so Republicans who have shown themselves to be willing to vote for any Obamacare repeal bill. It’s been the handful of final votes from the caucus’s moderate and conservative wings that has sunk every previous plan.

Those obstacles still remain: We still have not seen Sens. Susan Collin (R-ME) or Lisa Murkowski (R-AK) support a single repeal bill through this whole effort. Then again, they’ve often been reticent to oppose them up until the last minute — Murkowski still hasn’t come out against Graham-Cassidy, even after the decision not to hold a vote.

This is no doubt an obstacle but, in my view, not an immovable one. One thing I’ll be watching closely is how the Trump administration manages the Affordable Care Act. In about a month, it will begin its first open enrollment season. So far, it has taken steps that will hurt the marketplaces, slashing the advertising budget by 90 percent and in-person assistance by 40 percent.

Premiums will be higher in 2018 because the Trump administration has waffled on whether to make key payments.

If the marketplace ends this enrollment period in bad shape, that could change the dynamic in 2018. It could make the case for repeal stronger if the Affordable Care Act seems to be in dire straits.

Republicans lost an Obamacare battle on Tuesday. But right now, all evidence suggests they are not ready to stop fighting the war.

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