Republicans have made too many promises to repeal ObamaCare easily
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Eight months into the year, and Congress—especially the Senate—is still struggling to repeal ObamaCare. The impasse is a result of years and years of untenable Republican promises on health care that are now blowing up in their faces.
 
The GOP spent seven years promising their voters that they needed electoral wins in order to repeal and replace ObamaCare. Republicans promised that they would repeal ObamaCare and its mandates but keep the popular parts, like protections for pre-existing conditions and young people. They promised that they would replace it with a plan that would cost less and cover as many people as the law they were campaigning against. They also promised that they just needed a couple of electoral victories to accomplish it all, even when Democrats needed a majority of nearly unprecedented size to pass the Affordable Care Act in the first place.
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Voters gave Republicans the House, then the Senate, then the White House. The contradictory knot of electoral promises have all come to a head now that they’re in total control in Washington. The only reason Democrats were able to pass the ACA was that they had a super majority in the Senate, and they were able to get every one of their 60 votes on board. Single-party government of such magnitude hadn’t happened in over 30 years, and the last three decades of polarization meant that it was much easier to get everyone on the same page.

 

The dirty secret behind Republicans’ promise to repeal-and-replace is that they will never be able to pass a satisfactory plan with anything less than the 60 votes that Democrats had in 2009. The hybrid House-sponsored American Health Care Act and Senate-sponsored Better Care Reconciliation Act are the result of those governing constraints. With a mere majority, Republicans will have to pass legislation through the process of budget reconciliation.

That means any proposal to repeal ObamaCare—unlikely to garner a single Democratic vote—will have to pass the muster of the Senate parliamentarian, who can strike any provision that is not primarily related to the budget. It’s unclear if even a clean repeal, rather than a repeal-and-replace plan, would pass muster for reconciliation.

Too many Republicans have also endorsed the ACA protections for those with pre-existing conditions while eliminating the mandates to get a plan that will get a score from the Congressional Budget Office that will satisfy moderates. The way the health insurance market works, a mandate is necessary to keep everything functional if the government is prohibiting discrimination based on pre-existing conditions. Otherwise, healthy people can just wait to buy insurance until they truly need it.

There are ways around these complications, but only if Republicans can muster sixty votes. Conservative policy thinkers have for years been designing health policy plans that could protect pre-existing conditions, foster lower costs, and insure more people. But these plans would radically redesign our healthcare system; they are not budgetary tweaks that could pass through the reconciliation process.

Republicans could also pull a radical overhaul of the legislative process and abolish the filibuster. That would give them the ability to design a true replacement plan and pass it with the legislative majority they currently have. However, that would also make them vulnerable to accusations of hypocrisy: for years, they venerated the power of the minority filibuster as a governing tool.

Years of promises and campaign rhetoric have painted Republicans into a corner. Going back to the drawing board on healthcare is the only way they can untangle this web.

Kevin Glass is a policy advisor for the nonprofit Heartland Institute, an Illinois-based think tank aimed at promoting limited government.
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