Republicans are finally playing for keeps on ObamaCare. Now that they actually have the power to make President Obama's controversial health-care law disappear if they so choose, they're getting closer than ever before to the second half of "repeal and replace."
But after dozens of votes to repeal and almost as many competing ideas of how to replace ObamaCare, congressional Republicans are being urged to avoid repeating the Democrats' mistakes in drafting the law in the first place. Don't overpromise. Don't be too disruptive of people's existing health-care arrangements while promising nothing will change. Be transparent about costs and restrained in restructuring such a large segment of the American economy.
These are all good suggestions. But the Democrats of eight years ago deserve credit for one thing: They committed to a vision of health-care reform and stuck with it regardless of the political cost. Republicans have been unwilling to do this, perhaps until now.
The political price for the Democrats' steadfastness has been steep. Looming over President Obama's farewell tour is the fact that his party has taken a beating in down-ballot races during his time in office. ObamaCare isn't the only reason, but it's a big one. When the Affordable Care Act became law in 2010, Democrats enjoyed big majorities in both houses of Congress. Today, they are minorities in both houses.
As unpopular as ObamaCare has been, Republicans know they, too, could pay a steep political price in scrapping it. They were reminded of that during House Speaker Paul Ryan's CNN town hall last week, when a Republican got up and said ObamaCare had saved his life. Ryan handled the question well, but he is more articulate — and has more defined domestic-policy views — than your average House or Senate Republican. How many of them want to face constituents at town halls back home and have to say they repealed a life-saving law? Do Republicans really want to own all the problems in the country's health-care system?
So far, the evidence suggests the answer is no. That's a big reason why Republicans have avoided settling on an ObamaCare alternative for years. Just weeks ago, it looked as if they were going to once again repeal ObamaCare more or less symbolically while kicking the can down the road on replacement. And indeed, "repeal and delay" might have carried the day, except that President-elect Trump, who knows next to nothing about health-care policy, intuitively grasps that a gap between repealing and replacing the law is a political catastrophe waiting to happen. During a press conference last week, he said he wanted to see the law repealed and replaced "essentially simultaneously."
Unfortunately for Republicans, the new titular head of the party doesn't appear to have thought much about the issue beyond that, and won many voters of the "keep the government out of my Medicare" variety. Trump hasn't done anything to prepare these supporters, much less the nation, for retrenchment of the Medicaid expansion or any other entitlement. It certainly doesn't help when he promises the GOP's replacement plan will boast "insurance for everybody."
But cooler Republican heads understand that killing ObamaCare is politically perilous. Even the ill-fated effort to "defund" ObamaCare in 2013 was partially premised on the notion that once the law's subsidies kicked in, it would become impossible to replace without enraging Americans who had come to count on ObamaCare's benefits. Thus ObamaCare foes as staunch as Ted Cruz appeared to lack confidence that their health-care vision could carry the day unless they resorted to kamikaze missions before it fully took effect.
So what can Republicans do now?
From the time of the defeat of Bill and Hillary Clinton's health-care reform plan in the 1990s up until ObamaCare, the GOP barely coped with public anxieties about America's health-care system. They mainly just went along with low-budget knock-offs of Democratic plans with a handful of more market-based features cribbed from conservative think tanks: Kennedy-Kassebaum, the State Children Health Insurance Program, the deficit-funded Medicare Part D and, most ominously, RomneyCare.
If Republicans were never going to make the case for better functioning markets in health care versus more government direction, the issue was always going to be resolved on Democratic terms. In some respects, ObamaCare's unworkable mix of mandates, regulations, and subsidies represented a compromise between these two competing visions in spite of the GOP.
But it was not a sustainable compromise. Republicans have a chance to implement free-market health-care reform and forestall something closer to single-payer. But will they be willing to risk their fragile majorities to do so, as the Democrats who passed ObamaCare did?