Friday, January 13, 2017

Republicans' options on Obamacare

I don't know why so many commentators these days are so sure of a repeal.  Yes, the Senate passed a resolution clearing the way for a budget reconciliation (which I've addressed here as a way to avoid the 60 vote threshold and the nuclear option at the same time), but when enough Republican Senators pealed off and said that they would demand a "replace" at the same time as a "repeal," that should have been a big tipoff that this thing is far from over.  In 2009 and 2010, Obamacare was declared dead more times than a horror movie villain.  Repealing is hard.  Replacing is even harder.  With that in mind, let's just go through the options:

1)  Failure.  Failure is always an option.  If Republicans in the Senate won't "repeal" without a "replace," then repeal is contingent on "replace."  Replace is hard.  Lose three votes in the Senate (Collins, Murkowski and one more), and even with a purely budgetary replacement so that they can use "budget reconciliation" and avoid a filibuster, they can't pass it.  No replace = no repeal.

2)  Incremental change.  This can be done under the pretense that it will eventually go much further than it really will, but start passing repeals of things like the employer mandate and the medical device tax, make a big deal each time, and act like they will keep it going forever.  Eventually, the press will get distracted by OH MY FUCKING GOD, DID YOU HEAR WHAT TRUMP SAID?!

3)  Full repeal with the nuclear option.  No replace.  "Replace" is the pre-Obamacare system.  Yes, they can do this.  Eliminate the filibuster in the Senate on legislation the same way Harry Reid did for judicial nominations below SCOTUS, and just get rid of Obamacare entirely.  That way, we don't wind up with the non-budgetary requirement that insurance companies cover people with preexisting conditions without the financial support structures to make it possible, which would have created the health care death spiral.

4)  Full repeal with the nuclear option, replace with... something.  If the Republicans do a full repeal with the nuclear option, then they can structure a replacement however they want, touching whatever budgetary or regulatory systems they want.  It's just a matter of coalition-building.  Heh...  "just."  Funny, right?

5)  Partial repeal with budget reconciliation, partial replace with Democratic support.  I don't know why I am throwing this in here, because it is a pipe dream, but it seems to be somebody's pipe dream.  Repeal part of Obamacare using budget reconciliation (which the Senate set the groundwork for doing recently) on a party-line vote using only Republican votes because they can't overcome a Democratic filibuster, and then get some Democratic votes for a replacement.  This is one of two ways to get a replacement with non-budgetary stuff, because non-budgetary legislation can be filibustered.  The other is to go full nuclear, but if that's the tactic, then why not just start with the nuclear option?

6)  Partial repeal with budget reconciliation, partial replace without Democratic support.  Since this option is limited to budget reconciliation too, the replacement can also only be on budgetary stuff.  Neither the repeal nor the replace can touch the non-budgetary, regulatory structure of Obamacare.  Touching that requires either Democratic support, or going nuclear, but if they are going to go nuclear, just start with that.  McConnell already showed that he doesn't want to do that, for whatever reason.  We'll see how long that lasts, but that limits the options.

So, there you have it.  That's a lot that could happen, and failure is always an option on healthcare.

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