The Obamacare fight is on; here are 3 pitfalls Republicans will have to navigate
Posted January 5
The battle over Obamacare is on.
The Senate moved aggressively on Tuesday to start procedural efforts to overhaul the Affordable Care Act using a process called budget reconciliation.
The move signaled that Republicans are serious about dismantling President Barack Obama’s health care law, which has been plagued by legal challenges, rate increases and insurers leaving the marketplace since launching in 2014.
University of Utah political science professor James Curry said Republicans are making a high-stakes gamble by choosing repealing Obamacare as their top priority.
Senate Republicans can roll back enough provisions of the law through budget reconciliation to “fatally wound” it, said Curry, who studies policymaking in Congress.
But “replacing it is an entirely different story,” he said.
A successful repeal-and-replace will require Republicans to navigate at least three major pitfalls in the next few years.
1: Public opinion
With Republicans set on repealing first and replacing later, they are setting themselves up for a battle over public support, according to Curry.
"The danger of dragging things out is public opinion could turn against what you're trying to do," he said.
Roughly 20 million previously uninsured people gained coverage through the Affordable Care Act, mostly through Medicaid expansion.
Several other provisions of the law, including one that bans insurers from rejecting people based on pre-existing conditions and another that lets children stay on their parents' insurance plans until age 26, are popular with the public.
"To some degree, you’re taking away health benefits from people,” Curry said. “That gives Democrats the opportunity to try to say you're messing with people's health care."
Democratic leaders have promised to resist repeal efforts. On Wednesday, Sen. Chuck Schumer, D-New York, said that the GOP plan would "make America sick again."
Republicans in Congress will probably move to repeal Obamacare within the next year, according to Curry. But crafting a replacement will likely take much longer.
The repeal-first, replace-later strategy could be a risk for Republicans, Curry said.
"Once they repeal it, something has to happen," Curry said. "Both sides will try to leverage that deadline."
Democrats, knowing that Republicans need their support to pass a replacement, may try to put up roadblocks to get concessions.
Years of jockeying and negotiating could hurt Republicans if the fight drags on for too long, Curry said.
Republicans may wait to repeal Obamacare until after the 2018 midterm elections in an attempt to gain seats in the Senate. But if that doesn't go well, then they will face a re-energized Democratic Party and a weak majority.
"All of a sudden, now they have to pass a bill and they have to work with Democrats on it," Curry said. "It may not work out the way they hope."
It won't be hard for Republicans to gut the Affordable Care Act through budget reconciliation, even if they don't get to every provision.
That's because budget reconciliation, which is a process to accelerate action on tax- or spending-related legislation, requires a simple majority.
But passing new legislation in the Senate will require 60 votes — which means Republicans need to put together a replacement package that can gain Democratic support.
It's still unclear what might replace the law. Keeping popular provisions in the law without making cuts elsewhere could unbalance the insurance markets.
It’s "anyone's guess" how that will play out, Curry said.
But he predicts a prolonged, public fight between Democratic and Republican leaders over Obamacare's replacement.
"Given how divisive this whole policy area has been, it seems like the Trump administration may be the era of a prolonged fight over health care," he said.