For years, Republicans sought power by promising to repeal Obamacare in very concrete terms, and replace it with a mythical, ill-defined alternative that would accomplish all of Obamacare’s goals without entailing any of its costs or tradeoffs. The GOP’s unexpected consolidation of power in Washington should have marked the end of the line for this strategy, forcing the party to come clean with hard specifics. Instead, amazingly, Republican leaders tried to govern as they had campaigned.
The health care game plan they first adopted after winning control of the White House and Congress imagined a cascade of events, beginning with the passage of legislation to eliminate all of Obamacare’s taxes immediately, while setting an expiration date on Obamacare’s coverage expansion years well into the future. Having locked in a huge, regressive tax cut, Republicans would then turn to passing yet another huge regressive tax cut, and only then turn to the thorny question of what to do about the 30 million people who stood to lose their health insurance.
This repeal-and-delay strategy was so politically toxic that it became a dead letter before Donald Trump took the oath of office. Among the people who opposed the plan were Senator Rand Paul and, reportedly, Trump himself. “I think it’s imperative that Republicans do a replacement simultaneous to repeal,” Paul told MSNBC’s Morning Joe way back on January 4. This line of argument was persuasive to Trump, according to Paul. “He called after seeing an interview that I had done [talking about] that we should vote on Obamacare replacement at the same time,” Paul said. “He said he was in complete agreement with that.”
Trump’s stone-like mind appears not to have absorbed this very recent history, in which he was a key player, because after watching Senator Ben Sasse on Fox and Friends this morning, he impulsively revived the strategy.
Paul, eternally caught betwixt and between his uncompromising libertarian ideology and half a million newly insured people in Kentucky, has conveniently thrown his support exclusively to repeal strategies he knows lack enough political support to become law. When repeal-and-delay seemed like it might carry the day, he opposed it on the grounds that repeal-and-replace should be undertaken at the same time; now that Republicans are deep into negotiations to repeal and replace simultaneously, he’s become enthusiastic about the repeal-and-fill-in-the-blanks-later revival he once opposed.
The political and substantive shortcomings of repeal now and replace later were clear when it was first proposed, but the passage of time has exacerbated them in two ways. First, multiple Republican senators, like Paul, have publicly rejected that approach—returning to it makes liars out of them. More importantly, in the intervening months, Republicans have shown all their cards. House and Senate Republicans have both introduced their Affordable Care Act alternatives, and House Republicans have taken the reckless step of passing theirs.
Where immediately after the election Republicans could hope to hide behind abstraction and the false promise of a pristine replacement bill, their sputtering efforts to legislate health care in the interim have completely denuded them. The GOP may never reach consensus on how to replace Obamacare, but what we have learned during their brief time in power is that such a consensus would look like an odious Trumpcare bill that polls in the teens, or it would look like nothing.
The GOP spent the entire Barack Obama presidency pretending as though passing major health care reforms would be a cinch, if only they were given governing space to turn their great ideas into law. Invariably their promises to unveil and rally around those ideas never materialized while Obama was in office, and are now withering under first contact with reality. Their only fallback is to propose repealing Obamacare, while promising idly to replace it—to clean up the mess at some unspecified point in the future. Six months into a period of unified GOP rule, Republicans have stumbled backwards upon the only big health care idea they’ve ever had.