Normally, Donald Trump's tweet about healthcare this morning would've been the biggest news story of the day -- perhaps the biggest story of the four-day holiday weekend. For now, though, it's been more or less lost in the shadow of the Morning Joe story as well as the bombshell Wall Street Journal article connecting the dots between Russian hackers and the Trump campaign.
So, in case you missed it, Trump appeared to tip his tiny hand on what he said the other day would be a "surprise." Instead of passing Trumpcare, designed as a replacement for Obamacare even though it isn't equivalent in any way, Trump threatened instead to simply repeal Obamacare then pass a replacement later.
In case you can't see the screen grab above, here's the text: "If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!"
Two major problems with Trump's threat. First, if moderate GOP senators were opposed to repealing parts of Obamacare because it'd boot 22 million people from their insurance coverage, there's no chance in hell they'd vote for a full repeal of the law. Second, the Republicans don't have the votes to repeal the entire law because they'd have to whip a filibuster-proof majority -- 60 votes -- and they only have 52 total Senate Republicans. In other words, they can't repeal Obamacare by a 51-vote reconciliation maneuver.
Once again, Trump illustrates his own remarkable ignorance of basic Schoolhouse Rock-level civics.
However, it's possible though very unlikely that the Republicans could repeal the parts of the law that were passed via reconciliation with just 51 votes. Put another way, if Mitch McConnell could win over moderates for a reconciliation repeal vote, they could seriously cripple Obamacare. Again, it's very unlikely the moderates will go along with this. But for the sake of argument, let's talk about the law itself.
The ACA is much more than just the Patient Protection and Affordable Care Act. There’s the ACA law, of course, but there’s also another separate law that amended the ACA. Known as the Health Care and Education Reconciliation Act of 2010, this second ACA-related law contains all of the budget-related measures linked to Obamacare, including the individual mandate, the Medicaid expansion, the federal subsidies for lower-income Americans, the closure of the Medicare Part-D “doughnut hole,” a Medicare tax increase on Americans earning more than $250,000 and so on.
Things become more complicated when we discover that the Student Aid and Fiscal Responsibility Act was attached to the 2010 health care reconciliation act as a rider. This third piece of the ACA puzzle included major student-loan reforms, including the expansion of Pell grants as well as the implementation of President Barack Obama’s plan for eliminating private banks from the federal student aid program, effectively reducing student loan debt while also cutting the deficit by billions.
That’s certainly a mouthful. But all that stuff is part of the package collectively known as Obamacare. A party-line reconciliation vote could repeal the Health Care and Education Reconciliation Act. Every single reform you just read about in the previous paragraph (and more) would be vaporized. To repeat, the GOP needs only 51 votes in the Senate due to a rule that allows for a majority “reconciliation” vote on budget-related bills. The Senate Democrats can’t filibuster a repeal of the Health Care and Education Reconciliation Act and they lack the votes to block the reconciliation process unless a few moderate Republicans flip sides and join them -- a process we observed this past week.
In any case, the GOP needs only 51 votes in the Senate to repeal the mandate, the subsidies, the closing of the doughnut hole, the Medicaid expansion and all those tasty student loan reforms. Any “Never Hillary” millennials who voted for Jill Stein or stayed home because Clinton didn’t adequately adopt Bernie Sanders’ debt-free college plan should be especially alarmed by this news. So should elderly Americans, who’ll have no choice but to endure a grand reopening of the doughnut hole, forcing them to go without medication or to pay out of pocket for a month or two each year. Again, this is the part of the bill that the GOP will be able to easily repeal. And they will.
On top of all that, a 51-vote repeal of the Health Care and Education Reconciliation Act will also include a huge tax break for wealthy earners. When we say “huge,” we mean it. Scrapping this act will result in a $346 billion tax cut over 10 years for families earning more than $250,000. That’s great news for rich people, but horrible news for the rest of us. Making matters worse, repealing the 2010 health care reconciliation act — or doing away with it along with its sister-law, the ACA — could strip as many as 37 million Americans of their health care coverage. (Let’s do the numbers. There are about 12.5 million adults with coverage through the ACA, with another 18 million people covered under the Medicaid expansion, along with young people and kids who are covered under their parents’ plans or via the Children’s Health Insurance Program, which Obamacare expanded with greater benefits. Furthermore, if Republicans haphazardly repeal the law, it could destabilize the health insurance industry, forcing insurers to abandon the individual marketplace and retreating to strictly group plans.)
All told, yes, there's a path to repealing the budgetary aspects of Obamacare. It wouldn't kill the essential health benefits or any of the regulations. But it'd strip all financing from Obamacare. The good news is that they probably don't have the votes to do this anyway. The upshot is that Trump's idea is as foolish as his stupid hair and makeup.