This past week, Republican members of Congress held a retreat in Philadelphia. Of course one of the topics of discussion was what they were going to do about following through on their promise to "repeal and replace" the Affordable Care Act, or "Obamacare." On Thursday evening, The Washington Post received an anonymous email with a secret recording of a "repeal and replace" brainstorming session that reveals what many of us already know: the GOP not only has no clue of how to get rid of the ACA, they are nowhere close to a replacement.
In the 1990s, Republicans were successful in stopping what they were calling "Hillarycare," and, even though it was obvious that issues with our healthcare system were not going to go away, they offered no plan of their own. Even when the GOP owned Washington from January 2001 to January 2007 there was no discussion of healthcare. But when Republicans were unable to work up enough public opposition against Obamacare and it was signed into law, they immediately began attacking it, and pledging to repeal the law at their first opportunity.
The recordings sent to the WaPo and other outlets reveal that Republican lawmakers admit repeal will be a tricky process, and one that could be politically damaging to them and their party. That runs counter to their public suggestions that Obamacare can be quickly and easily done away with, and replaced with something "wonderful," as Dear Leader Trump has promised.
One issue the GOP has encountered is a mechanism for paying for a replacement. Republicans have latched onto a report that says repeal would save some half a trillion dollars through 2027. But, as Senator Rob Portman told the meeting, the money to pay for a replacement law would have to come from somewhere. "This is going to be what we’ll need to be able to move to that transition," he told the gathering.
To deal with this funding problem, some Republicans are suggesting a new middle class tax to pay for a new healthcare law. Right now, if you get your health insurance benefits through your employer, those benefits are tax-free. But at least a portion of the GOP thinks taxing employer sponsored plans is a great way to pick up the tab for an Obamacare replacement. Louisiana senator Bill Cassidy observed correctly,
It sounds like we are going to be raising taxes on the middle class in order to pay for these new credits.
This shifts the tax burden from the rich, where it currently rests, to the middle class.
Representative Tom McClintock (R-CA) warned his colleagues that they need to move cautiously, due to not having a 60 vote filibuster-proof majority in the Senate. Items in Obamacare that affect the budget can be repealed through reconciliation, which only requires 51 votes. But the entire law can't be repealed that way, and it is unlikely that many, or even any, Democrats would side with the GOP. McClintock said,
The fact is, we cannot repeal Obamacare through reconciliation. We need to understand exactly: What does that reconciliation market look like? And I haven’t heard the answer yet.
McClintock also cautioned the group that whatever comes out of the process would belong totally and completely to Republicans.
We’d better be sure that we’re prepared to live with the market we’ve created. That’s going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.
New Jersey representative Tom MacArthur brought up a concern about what would happen to the people now covered through the ACA marketplace or under Medicaid expansion. MacArthur cautioned,
We’re telling those people that we’re not going to pull the rug out from under them, and if we do this too fast, we are in fact going to pull the rug out from under them.
One Republican who appeared to not share the concerns of others was House Speaker Paul Ryan. He said,
We have a responsibility to work for the people that put us in office. That’s the oath we take: to defend the Constitution, to fight for the people we represent, and this is a fiasco that needs to be fixed.
Ryan misses the fact that each of the Republicans at the retreat represents not just the people who voted for them (and of course campaign donors), but everybody who lives in their districts. For many of them that includes a fair number of people who receive benefits through the ACA.
Reporter Mike DeBonis noted in his WaPo story that many of the concerns over the repeals and replace process that were raised were oriented toward politics, not policy. Not surprising, given that most Republicans are pure political animals. They exist in government not to serve their constituents, despite Ryan's claim, but to serve large campaign donors and to maintain their grip on power. You can be certain that as plans for an Obamacare replacement move forward, maintaining power for the GOP will be of paramount concern.
Greg Sargent, who writes "The Plum Line" column at WaPo, thinks the mere fact that Republicans are discussing Obamacare in private is a good thing. But he also raises a pertinent question:
[I]t is useful to see Republicans wrestling with the fact that repeal (and replace) will bring major challenges and could produce a terrible outcome in humanitarian terms. But we have to ask: Given that Republicans have supposedly been preparing for the chance to repeal (and replace) the ACA for years, why do they seem so surprised by this?
I think I have an answer. Rhetoric aside, they haven't been preparing a replacement because from day one they never intended to do anything about it. They expected the law to get derailed somewhere along the way, most likely in the courts. Some probably saw Obamacare as a useful rallying cry for their base, in the same way they have used abortion since Roe v. Wade. But what very few of them probably expected was that Donald Trump would win the presidency and they would actually have to try and keep their promise to bring an end to Obamacare.
This means that Republicans have been lying to their voters for the better part of a decade, billing themselves as the implacable foe of a law based on their own ideological principles. Now they're faced with the impossible task of replacing that law with something "better" and they don't know what to do. Governing is much harder than throwing rotten tomatoes from the back of the crowd and the Republican Party is going to pay the price for their dishonesty.
No wonder they're starting to panic.