Republicans do have a plan to replace Obamacare, but the repeal process is complicated

Over at MinnPost, Eric Black penned a rant claiming Republicans have no plan to replace the Affordable Care Act, which, according to Black, suggests Republicans are not serious about governing.


The notion that “a real plan doesn’t exist,” as Black writes, is simply false.  Last June Speaker of the House Paul Ryan released A Better Way, a comprehensive plan to replace Obamacare that received broad support among Republicans.  Importantly, Tom Price—President Trump’s pick to lead the Department of Health and Human Services (HHS)—is among the many Republicans who have publicly advocated for Ryan’s plan.

Any reporter covering this area knows of the plan and can draw the common sense conclusion that this is the likely starting point for any effort to repeal and replace when both the Speaker of the House and Trump’s choice to head HHS campaigned on the plan.

Nonetheless, Black failed to mention the Ryan plan.

Black also failed to mention what is truly confounding Republicans right now.  Despite controlling Congress and the Presidency, there is no clear legislative path for Republicans to fully repeal the ACA.

Any reporter covering this area knows that a full repeal of the ACA will almost certainly take 60 votes in the Senate to overcome a filibuster.

Republicans can repeal much of the ACA through the budget reconciliation process with only 51 votes.  Basically, the budget reconciliation process permits legislative provisions that result in changes to budgeted spending and revenue to pass on a simple majority vote.  But most observers agree that the Senate Parliamentarian would not allow budget reconciliation to be used to repeal the ACA’s insurance regulations.

This presents a serious problem for Republicans.  The reason rates in the individual market are rising so dramatically is because ACA regulations allow people to wait until they are sick before they buy coverage.  Imagine how homeowner’s insurance would work if you could wait into your home was on fire to buy coverage.  Obviously, it wouldn’t work and the same is now abundantly clear for health insurance.  Without question these insurance regulations are the most disruptive element of the ACA and yet Republicans can’t fix them without getting 60 votes in the Senate.

Why not just repeal what they can through the reconciliation process?

Unfortunately, repealing ACA provisions with a budgetary impact while at the same time leaving the ACA’s insurance regulations in place risks further disruption to the individual market.  In particular, the individual mandate taxes and individual premium tax credits are helping to keep some healthier people in the market.  Repeal those items through reconciliation without more and watch fewer healthy people enroll in the market.

Ultimately, the need to gain 60 votes in the Senate to repeal the ACA’s insurance regulations severely complicates any Republican repeal and replace plan.  That complication—the reality that Democrats still wield power over the process—is why we see some Republicans talking about repairing versus repealing and replacing.   As Sen. Lamar Alexander explains, “ObamaCare wasn’t passed by reconciliation, it can’t be repealed by reconciliation. So we can repair the individual market, which is a good place to start.”

But many Republicans think full repeal is still doable.  And they might be right.

Far from a failure to govern, this ongoing and deliberative conversation among Republicans is exactly what America should expect from elected officials who take their obligations seriously.

Furthermore, Americans should find comfort in the fact that Republicans are following Speaker Ryan’s leadership on this issue.

Ryan knows a thing or two about health care.  As America debated health reform back in 2009—before Ryan stepped into any leadership roles in the House—it was Rep. Ryan who led the development of the Republican alternative to Obamacare, the Patients Choice Act.  This legislation offered a strong patient-centered alternative to Obama’s centralized federal regulation of America’s health care system.  Moreover, it demonstrated Ryan’s firm grasp of the health care problems facing America, the details of what must be done, and the consequences of getting it wrong.

Speaker Ryan’s unusual blend of leadership and policy expertise is exactly what is needed to steer federal policy to support a better health care for all Americans.