Why Republicans are balking at replacing Obamacare, again

Why We Wrote This

The White House this week pressed to improve health care by nullifying Obamacare through the courts. But Republican lawmakers see targeted fixes as a more viable path to progress.

J. Scott Applewhite/AP/File
In September 2017, Republican lawmakers speak to the media on Capitol Hill after the defeat of the Graham-Cassidy bill, another attempt to repeal and replace the Affordable Care Act. From left, Sen. Lindsey Graham, R-S.C., Sen. John Barrasso, R-Wyo., Sen. Bill Cassidy, R-La., Senate Majority Leader Mitch McConnell, R-Ky., and Majority Whip John Cornyn, R-Texas.

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Two years ago, when Republicans controlled Congress and the White House, they couldn’t agree on a replacement for the Affordable Care Act. This week, President Donald Trump again put repeal of Obamacare back on the table. He declared that Republicans will be “the party of health care.”

The president says he wants to tackle health care head-on. But there’s no replacement plan yet. And Republican lawmakers have no appetite for another bruising party battle over what might replace Obamacare.

“Relitigating” past policy battles is “a mistake,” said Rep. Mark Meadows of North Carolina, a close ally of the president and member of the conservative Freedom Caucus. Some Republican lawmakers are looking to address specific flaws in the U.S. health care system. Sen. Susan Collins of Maine, for example, is working on bipartisan solutions to lower the cost of prescription drugs.

“That’s a potential issue that I think could unite the administration, Democrats, and Republicans,” Senator Collins says of prescription drugs. “That is not, however, in any way, a broad substitute for the Affordable Care Act.”

Gasps went up from the Senate floor two years ago when Republican Sen. John McCain gave his late-night thumbs-down to the GOP’s rollback of Obamacare. His vote against his own party broke a tie and snatched the controversial Affordable Care Act from the jaws of death.

Senator McCain, who had campaigned on repealing and replacing Obamacare, criticized the hasty and secretive process in which Senate Republicans threw together their bill, dubbed “skinny repeal.” But as he wrote in his memoir, “The Restless Wave,” the bigger problem was that the bill, while likely causing Obamacare’s collapse, “offered literally nothing with which to replace it.”

The late senator’s lesson about an empty replacement is worth remembering in a week in which President Donald Trump unexpectedly – and many say unwisely – put the GOP back in the battle with Obamacare, says G. William Hoagland, senior vice president of the Bipartisan Policy Center in Washington. While a wholesale replacement looks unlikely now, some Republican legislators see a path to lowering health care costs by, for instance, tackling the cost of prescription drugs. 

A GOP surprise

The president surprised Republicans on Monday by throwing his administration’s legal weight behind a federal appeals court case to void the law entirely. The case may well reach the highest court in the land. Turning perception on its head, the president then declared that Republicans will become “the party of health care,” and if the Supreme Court rules that “Obamacare is out, we’ll have a plan that is far better than Obamacare.”

But there is no sweeping replacement plan, and Republican Senate majority leader Mitch McConnell does not intend to figure one out. The Kentuckian is waiting for the White House to come up with one, he told Politico, while he focuses on attacking Democrats’ “Medicare for all.”

Other Republican senators echoed him. As Sen. Lamar Alexander, R-Tenn., pointed out with a laugh this week, Republicans could not pass “repeal and replace” even when they controlled both houses of Congress.

“The biggest problem I have, even if you’re for repeal, it’s always repeal and replace,” says Mr. Hoagland, a health policy expert who worked for many years for Senate Republicans. “By taking this court case, he’s taken the position of repeal, but we don’t have a replacement.”

After nearly 10 years as law, a flat-out repeal would deprive 20 million people of insurance, roll back Medicaid expansion, prevent young adults from piggybacking on their parents’ plans, and end protections for people with preexisting conditions, among other things. Over time, the law has become more popular, not less. It has flaws that need fixing, says Mr. Hoagland, but the idea of doing away with it absent an alternative “is terribly unthoughtful” and politically inept, he adds.

The Justice Department’s move and the president’s plan pronouncement dropped from the sky like a tornado, surprising Republicans on Capitol Hill who have pointedly avoided any replay of the party division and defeat over Obamacare. It also came during a week in which the administration lost two court cases attempting to change the Affordable Care Act (ACA) coverage. On Wednesday, a federal judge blocked the introduction of new work requirements for Medicaid recipients in Arkansas and Kentucky, ruling that the changes undermined the purpose of the program to provide health care for low-income Americans. On Thursday, another federal judge called a plan for small-business health insurance an “end run” around consumer protections provided by the ACA.

But the president lays great worth on fulfilling his campaign promises, and repealing Obamacare has been left undone. At the same time, he told Senate Republicans that he wants to get the upper hand on health care as the 2020 presidential campaigning begins.

But the issue is fraught with political peril, especially for Republicans facing tough Senate races in 2020. Yes, it motivates their base, but last year the promise to protect Obamacare helped propel Democrats to their biggest gains since Watergate, handing them 40 seats in a House takeover. The White House was divided over this week’s health care strategy, with even the vice president and attorney general opposed, according to media reports.

“We’ve never, in the history of the party, ever had an advantage over the Democrats on health care as an issue,” says Republican pollster Ed Goeas of The Tarrance Group. 

Indeed, Democrats happily pointed out the contrast between the parties as they rolled out House legislation to buttress the Affordable Care Act at the same time the administration pushed to void it in the courts.

On the Hill, Republicans focused on skewering the Democrats’ “Medicare for all” idea as a government takeover of health care. That’s much safer ground for Republicans, according to Mr. Goeas. Seniors, a powerful voting group, fear adding more people to a program that is in jeopardy for funding and for which they already have to wait in line, he says.

And when Republicans talk about health care legislation, it’s in more focused ways.

Going back and “relitigating” past policy battles is “a mistake,” said Rep. Mark Meadows, a close ally of the president and member of the conservative House Freedom Caucus. Instead, he said, Republicans should concentrate on protecting preexisting conditions and lowering the cost of prescription drugs. The Republican from North Carolina was at the center of the GOP’s wars over repeal and replace, and he joked that he’s now got a Ph.D. in health care policy that was never on his bucket list.

Piecemeal reform plan

Sen. Susan Collins, R-Maine, who joined Senator McCain in voting against Obamacare repeal, says the only way a health-care plan from the White House could become reality would be to work with House Democrats, but that would be “very difficult.”

But the senator, who chairs the Senate’s Special Committee on Aging, thinks bipartisan consensus could be reached on lowering prescription drug costs. The president has already signed two of her related bills, including one to prohibit concealing lower drug prices for consumers at pharmacies. She’s working on a third bipartisan bill – to reform the patent process to make it easier for new, lower-cost biologic therapies to emerge. 

On Friday, Republican Sen. Rick Scott of Florida introduced a bill to prevent drug companies from charging U.S. customers more than they charge other developed countries, like Canada. 

Democrats say they are having staff-level discussion with the administration about drug costs, but they do not characterize them as negotiations. “That’s a potential issue [drug costs] that I think could unite the administration, Democrats, and Republicans,” Senator Collins says. “That is not, however, in any way, a broad substitute for the Affordable Care Act.”

The president, she says, would be better served by trying to amend the act and give states more flexibility on how they implement it, “than trying to invalidate the entire act in court before he has any comprehensive plan.”

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