The Insanely Favorable Politics of Repealing and Never Replacing Obamacare
To understand just how easy it would be to repeal and never replace Obamacare, all you have to do it count.
Thanks to budget reconciliation, it only takes a majority in the House and 50 votes in the Senate (plus a Vice-Presidential tiebreaker) to gut Obamacare of nearly all its funding. The letter of the law will stay on the books, but without the money to subsidize health insurance on the exchanges or to pay for the expansion of Medicaid, the mechanisms used to provide affordable health insurance will simply collapse.
Replacing Obamacare, however, will take 60 votes in the Senate. Why? Because Republicans want a new healthcare law, and it takes 60 votes to overcome a filibuster. Otherwise, anything Congressional Republicans pass with 50 votes in the Senate will just be fiddling around with the current law, and the only thing a majority of Congressional Republicans agree on in is repealing that law.
Republican leaders have thus messaged the process to come as this:
- Repeal Obamacare
- Have repeal go into effect a year or more from now
- Negotiate with Senate Democrats to get a bipartisan deal and prevent Armageddon
It’s step three here that should scare you. On the surface, it looks like Democrats have plenty of leverage. They can just hold the line, demand a bill just as good as Obamacare, and if nothing passes, then Congressional Republicans will be responsible for throwing 20 million Americans off their healthcare plans.
But in reality, the politics are relatively favorable for Congressional Republicans, and point to repeal without any replacement.
How so? Let’s count the ways:
- Healthcare as a political issue is an asymmetrical fight. Older Americans who already have access to affordable medicine through Medicare mobilize when their healthcare is on the line. This time may be different, but the 28-year-old on the private exchange hasn’t really shown any such pluck thus far. In the six years since Obamacare has passed, beneficiaries of Obamacare have rarely shown up at the ballot box.
- In a game of chicken involving people’s healthcare, Democrats will blink first. How many Democrats would be willing to sit back and watch as millions of their constituents lose access to healthcare? Congressional Republicans have already voted time and time again to repeal Obamacare. They’re locked in. They truly want the law gone. Individual Democrats, on the other hand, would be easy to pick off as they try to shield their constituents from the possibility of losing all access to healthcare. Plenty of Senate Democrats will want to play ball, either because they’re up for reelection in 2018 or because they came to the Senate to compromise. Even if no deal comes of it, these Democratic Senators will take a lot of the political heat off of Congressional Republicans.
- Thanks to gerrymandering and a favorable 2018 map, Congressional Republicans really don’t have much to fear from the broader electorate. If you’re a Republican member of Congress, you fear much more a primary challenge than losing in a general election. Most Republicans are in danger of losing their seats if they don’t repeal and sustain a repeal of Obamacare.
- Inertia. Inertia. Once repealed, the law will start to collapse even with a deadline way in the future. Why? Private insurers aren’t going to operate in marketplace with an expiration date. Acknowledging that repeal had anything to do with this will be political suicide. Congressional Republicans will have every incentive to blame Democrats for not “dealing” and walk away from this dumpster fire. And if Congress is good at one thing, it’s doing nothing.
Even if you don’t buy the above logic, there are only two real scenarios at play here: either we get a historic bipartisan healthcare plan known as Trumpcare, or Obamacare simply dies. One of these outcomes already has the votes. The other will require a bipartisan legislative effort most of us have never seen in our lives.