Repeal Obamacare immediately, experts warn, and millions of people will be loseinsurance. Repeal it with some kind of three-year transition and experts warn you could throw health insurance markets into chaos. And in both of those scenarios, Republicans are still saddled with the daunting task of coming up with that fabled replacement. (That thing that they have promised over and over again to unveil, but have never really delivered on.)
So what happens if Republicans move forward with a plan to repeal Obamacare now and then replace it three years from now? A lot of political smoke and mirrors. That's what.
The latest is that Republicans will repeal Obamacare right away in January using a process called budget reconciliation, which lets them repeal budgetary items with just 51 votes in the Senate. Then, Republicans will enact a self-imposed deadline roughly three years from now before they have to pass a replacement plan. How much of the existing Obamacare elements will limp along until then remains unclear, and whether you can repeal some but not all of Obamacare without causing it to collapse is a big open question.
But such a scenario also creates a self-imposed crisis that Republicans hope will pressure Democrats into coming to the negotiating table down the road. This is where clarity is crucial. Three years from now, it's not the Democrats' crisis. It's a Republican one. There is no health care cliff, Obamacare doomsday, congressional-health-care-death-spiral apocalypse unless Republicans create one by repealing Obamacare without a replacement plan.
"I don't think they've got their act together on this," said Norm Ornstein, a congressional scholar at the American Enterprise Institute who has been extremely critical of the modern-day GOP.
There is still debate about whether at the end of those three years Republicans will need Senate Democrats or not. Budget experts, Hill staffers and members agree you can repeal most of Obamacare through budget reconciliation, but it's unclear if it could be used to replace it. It depends in large part on what the replacement plan looks like.
By creating some kind of self-imposed health care do-or-die moment at the end of 2019 or early in 2020, Republicans are either making a strategic calculation that their Senate gains in 2018 will be such that they will have an easier chance of passing a replacement bill in the Senate or they are hoping that Democrats will have to shoulder the blame if GOP as the majority party can't make good on its replacement promise.
"It's partly a scam and a sham," Ornstein said. "They know they cannot do this with a Senate filibuster and the limitations of reconciliation and that it's likely that they cannot get every Republican ... they can do the same thing with health care that they tried with the debt ceiling. Basically, 'you better cooperate with us or we kill the hostages.'"
Over the last week, Republicans have started floating that new messaging strategy.
During a pen and pad with reporters on Tuesday, House Majority Leader Kevin McCarthy (R-CA) hinted that he was looking for a way to get Dems to help once Obamacare was repealed.
"My personal belief and nothing has been decided yet. I would [move through] and repeal and then go to work on replacing," McCarthy said. "I think once it is repealed you will have, hopefully, fewer people playing politics."
In the abstract, there are certainly fixes Democrats would be interested in working with Republicans on, especially red state Democrats who are facing re-election in 2018. But pulling the rug out from under Obamacare rather than fixing it right away may backfire for the GOP.
"No one is saying it is perfect," said Judy Solomon, a policy expert at the left-leaning Center for Budget Priorities. "That is a conversation that people would very much like to have."
"They've used these talking points for 10 years and they are regrouping," Sen. Sherrod Brown (D-OH) told TPM. "We're going to name victims. The young women who are going to lose their birth control coverage ... How about the 600,000 Ohioans who are going to lose their health care? How about the seniors who are going to pay more for their drugs. We are going to name names when they go after these people."
When Lamar Alexander (R-TN), chair of the Senate Health, Education, Labor and Pensions Committee, began laying out Republicans' best course of action to repeal and replace Obamacare weeks ago he urged "humility" and "patience." He offered a bit of advice about calls to swiftly repeal Obamacare on a lurch.
"What we need to focus on first is what would be replace it with," he said.
Then he offered another stark warning.
"We've spent six years as the Hatfields and the McCoys, you know, adopting our positions and shooting each other, so building consensus in an environment like that is hard to do. But if we keep in mind we are trying to help people who are hurting and trying to keep other people from being hurt, maybe that will encourage consensus," Alexander said. "If we want a lasting solution, eventually we're gonna have to have 60 votes in the Senate to get it."
The way to do that is not to rip apart Obamacare immediately and then act like Democrats are required to stem the bleeding.