Sunday, December 11, 2016

Repealing and Replacing Obamacare Schadenfreude

The big question is not whether Obamacare will be dismantled, but how and how fast:

After Repeal - GOP's game plan for undoing Obamacare
It didn't take long for Republican leadership in both houses of Congress to get over the shock of winning the election last month and start gaming out a repeal plan. The details remain under discussion, but House speaker Paul Ryan, Senate majority leader Mitch McConnell, and Vice President-elect Mike Pence (who is working closely with Ryan and McConnell on repeal) are already coalescing around a rough legislative framework. The plan might be summed up as: repeal, delay, replace. More precisely, Republicans plan to repeal most of the law, delay the implementation of most of that repeal for at least two years—and figure out what to replace it with in the interim.

It's a legislative strategy adopted largely from the Heritage Foundation's recommendations. The think tank's health care experts Nina Owcharenko and Edmund F. Haislmaier authored a brief in November that advocated a four-step process that begins: "Maximize the reconciliation process for repeal." According to Mitch McConnell, this will come in the form of an "Obamacare repeal resolution" on January 3, the first day of the new Congress.

Why start here and not a straightforward repeal bill? While such a repeal could pass the House of Representatives with a party-line vote, the small majority Republicans hold in the Senate (likely 52 to the Democrats' 48) means there's no supermajority of 60 to override an almost-certain Democratic filibuster. So the GOP plans to repeal Obamacare the same way Democrats passed it: through budget reconciliation, because Senate rules limit debate (and thereby avoid the filibuster threat) on budget legislation.

This process, however, also limits what Republicans can repeal. Obamacare's taxes and penalties (which are the muscle behind the individual and employer mandates), Medicaid expansion funds, subsidies for health-insurance exchange customers, and taxes on the health care industry are all on the reconciliation chopping block.

Dumping all of this would effectively cripple the law's enforcement, even if the statute itself remains on the books. It will be up to the administration to undo the regulatory regime of Obamacare in the executive branch.

This is hardly a new plan. Shortly after taking control of the Senate in 2015, Republicans in both houses passed a nearly identical budget reconciliation bill, but President Obama vetoed it. President Trump, almost certainly, would not. . .
Chuck Schumer on GOP’s “repeal and delay” plan for ObamaCare: “They’re giving us tremendous leverage”
Yeah, it’s hard to disagree. If you missed this post from a few days ago and haven’t followed the “repeal and delay” saga, try to force yourself through it to prepare for the long three-year slog ahead. It’s boring vote-counting stuff for the most part but it’s high high high stakes. Here’s the simplest possible version: What happens if the GOP sets a time bomb to blow up ObamaCare in 2019? Can they “defuse” the bomb by replacing O-Care with a new Republican-made insurance system before it goes off? And if they can’t and it does go off, which side is likely to suffer more political casualties? Trump and the GOP or Schumer and the Democrats?
Rush on ObamaCare: The GOP’s “repeal and delay” plan is a disaster waiting to happen
Rush’s plan is to set the bomb off now. Forget delayed repeal. Repeal the law immediately, even though there’s no Republican (or Democratic) plan waiting to replace the ObamaCare exchanges once they go up in smoke, and let the political chips fall where they may. The market will find a solution. That’s a … daringly libertarian-ish solution coming from a guy who’s spent time lately defending Trump’s Keynesian stimulus plans. But Trump will never go for it. He once famously said when asked about health care during the primaries, “You’re not going to let people die sitting in the middle of the street.” If the GOP nuked ObamaCare and dumped the rubble on the insurance industry to clean up, Democrats would spend every day of his presidency screaming you’re letting people die in the middle of the street. His political image is one of the paternal strongman who’s going to protect his people. “Your insurance is gone, fend for yourself” is not a position consonant with that image. In fact, given the risk of a ferocious political backlash from canceling the exchanges without a stopgap plan in place, I doubt even President Cruz would have entertained that possibility.
Freedom Caucus opposes GOP's Obamacare replacement plan
The proposal “will meet with major resistance from Freedom Caucus members,” the North Carolina Republican vowed in an interview, calling it “the first big fight I see coming for the Freedom Caucus.”

“It should be repealed and replaced, and all of that should be done in the 115th Congress” — the two-year period starting in January through 2018 — and “not left to a future Congress to deal with,” Meadows added.

Politico reported last week that GOP leaders on both sides of the Capitol are coalescing around a two- or three-year repeal strategy, which would allow them ample time to come up with a replacement and give insurance companies time to adjust. The Senate is particularly keen on a three-year phaseout, though nothing is set in stone.
I tend to agree. Two years should be long enough to make the changes. No need to delay into the next Congress.  Take enough time to think it through and get it as right as possible but, Git 'er done.

Democrats Plan Fight to Save Obamacare
The emerging strategy is centered around highlighting people who have benefited from the law and who would lose insurance coverage or key consumer protections if it goes away. “We have to lead with them and their stories,” said Jeremy Bird, a Democratic strategist who served in senior roles for both President Obama’s reelection campaign in 2012 and Hillary Clinton’s campaign this year. “This is about what Trump and the Republicans want to take away from working families across the country, and we have to make that very clear this is what we’re talking about.”

Organizers say they’ll announce details about the coalition on Friday, but the efforts could include rallies both in Washington and in the states and districts of Republican members of Congress. It might also involve television advertising, although Bird said the most important part of the drive would be mobilizing constituents—including Trump voters who would be negatively affected by repeal—on the ground across the country. “I think that’s more important than some barrage of national ads,” Bird said. “That strategy is not going to work anymore in the future. It’s got to be about grassroots organizing. It’s got to be about real people who are constituents of these folks making it known.”
So expect more ads showing Paul Ryan shoving Grandma off the cliff?

And from the somewhat sensible Megan McArdle a reminder of how we got into this dilemma : You Can Argue What Ought to Be, or Make It Happen
There are countless “blank check” theories of politics from both sides. The time I suggested to Obamacare’s supporters that passing the program on a straight party-line vote, using a somewhat obscure parliamentary maneuver that left the bill in dire need of new legislation to fix its flaws, might tend to make it a wee bit politically unstable. (I was told that then it would be Republicans’ fault, so supporters weren’t responsible for what might happen to the insurance market.) 

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