WASHINGTON -- At long last, congressional Republicans have honored a pledge to conservatives and repealed President Barack Obama's landmark health care reform plan. Sort of.
A mere 2,116 days after Obama signed the Affordable Care Act, the House voted 240-181 Wednesday on a Senate-passed measure to eliminate the most important parts of Obamacare.
Republican leaders are portraying the move as a promise fulfilled after dozens of previous House votes to repeal, defund or otherwise trash the Affordable Care Act. And the bill heading to the White House would indeed kill vital parts of the law, such as its health insurance subsidies, its expansion of Medicaid to low-income adults and the mandates that most Americans get health coverage and that large employers provide it to workers.
The next thing that will happen is the repeal bill will speed its way to Obama's desk, where he will promptly veto it and carry on with whatever else he was doing.
Self-congratulatory press conferences won't change the fact that Republicans haven't actually repealed anything and are nowhere near proposing their long-awaited "replacement" plan, despite new pledges from House Speaker Paul Ryan (R-Wis.) and other leaders.
In the meantime, millions of Americans will continue enrolling in health insurance on the law's exchange marketplaces, and millions more will keep using the health plans and Medicaid benefits they already have.
Republicans took over the House in 2011 and the Senate in 2014. GOP leaders in both chambers spent months last year hashing out this repeal bill and negotiating with the Senate parliamentarian about what they could put in it. They passed it three times (first in the House, then in the Senate, and now in the House again). But all they'll have to show for it is a stack of paper with the president's veto on it.
Repeal diehards told their supporters they could force Obama to cave on the Affordable Care Act, which they attempted to do when they shut down the government and threatened to withhold a debt limit increase and default on the country's debts. But Obama was never going to sign a bill that eliminated his signature domestic policy achievement -- especially one so tied to his presidency that it's been unofficially named after him.
And although finally sending a repeal bill all the way to the White House may look like a victory in the War on Obamacare, it's a hollow one at best. Conservative voters won't be satisfied with just a veto, and everyone is still waiting for Republicans to propose a replacement, not simply kick people off the health insurance rolls and increase the ranks of the uninsured by 24 million over 10 years.
That's why repeal alone isn't politically tenable. For evidence, look to Kentucky Gov. Matt Bevin (R), a tea party favorite who accused Sen. Mitch McConnell (R-Ky.), the Senate GOP leader, of being insufficiently anti-Obamacare during an unsuccessful 2014 primary election challenge.
Bevin campaigned for governor last year on a pledge to rescind the state's Medicaid expansion and kill off its health insurance exchange, Kynect. He still says Kynect is done for, but his position on Medicaid expansion shifted as election day approached, and last week Bevin announced he would negotiate with federal authorities on changes to the Medicaid expansion instead.
Likewise, Arkansas Gov. Asa Hutchinson (R) took office last year and ignored cries from conservatives to undo the expansion. Instead, he has merely proposed requesting federal permission to modify it.
Even in Congress, a handful of Senate Republicans nearly got cold feet about the repeal bill in November, and GOP Sens. Susan Collins (Maine) and Mark Kirk (Ill.) ultimately voted against it.
The exchange between Fox News anchor Bill Hemmer and House Budget Committee Chairman Tom Price (R-Ga.) on Tuesday, which can be seen below, is revealing. Even on the precipice of what they want to be seen as a win on Obamacare, the congressional GOP leadership has no answer to the question of what comes next.
Hemmer tried repeatedly to get Price to explain what Republicans want to achieve on health care, and when they will have their official plan ready. He failed, as this portion of the interview demonstrates:
Hemmer: I'm going to bounce back to you yet again on the idea of what you replace Obamacare with. And that really is the linchpin for this entire debate. What will Republicans do? What will they fashion in terms of a bill that replaces Obamacare? What does it look like?
Price: This is why I'm so excited about the new leadership of Speaker Ryan. What he has done is charging the committees in the House of Representatives that work on health care to come forward with a positive solution, a common-sense solution, a patient-centered solution, that puts patients and families and doctors in charge of health care, and not the federal government.
And we'll do that over a period of a number of months. This isn't going to be top-down, like Obamacare was. This is going to be a bottom-up, organic process that brings together over a hundred pieces of legislation that are currently in the House of Representatives that deal with health care, and comes forward with those positive solutions that recognize the principles.
Price's comments mainly consisted of a hodgepodge of talking points that Republicans have been using since 2009, when the Affordable Care Act debate began, without saying much about what they actually want to do.
And having more than a hundred pieces of health care legislation (one of which Price himself has been pushing fruitlessly since 2009) is a sign of how far the GOP is from consensus, not an indication of how close the party is to a post-Obamacare health care reform platform. These bills also wouldn't "replace" the Affordable Care Act in any meaningful way, because they don't even attempt to cover the uninsured or to enact consumer protections like a guarantee of coverage to people with pre-existing conditions.
And then there's the process Price describes, in which GOP lawmakers put their noses to the grindstone and come up with a plan they can pass.
That should sound familiar, because Republicans leaders have said it before. In 2015. In 2014. In 2013. In 2012. In 2011. And in 2010, as soon as Obamacare became law.
But the presidential election is one reason why this year may be different. If a Democrat is elected president, the stalemate continues. But if a Republican winds up in the White House instead, this repeal vote could portend some real internal strife for the GOP.
Republicans would no longer be able to blame Senate Democrats or Obama for their failure to coalesce around a health care plan. With control of Congress and the White House in their hands, the onus fully would be on GOP lawmakers to work with their new president to live up to their promises of a better health care system and to take ownership of the reality that whatever they propose will create winners and losers, just as Obamacare did.
That grand bargain has, so far, eluded them. And if the past six years -- plus the decades that preceded them -- are any indication, it will continue to.
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