In it, but not of it. TPM DC

GOP Faces Big Dilemma As Its Obamacare War Fizzles: What Next?

E0dz5yag8gvdgu75mqxi
AP Photo / Carolyn Kaster

For five years they profited politically from waging an all-out assault on Democrats' push to cover the uninsured. Republicans united against Obamacare in the bill's infancy and proceeded to turn the sprawling new law into a political liability for Democrats by persuading Americans that it would imperil their access to health care.

"Repeal and replace" was the mantra -- although while Republicans forced more than 50 votes to repeal or undo the law they never coalesced around a replacement. Last month, after the law surpassed its 7 million signups target, numerous conservative experts warned that the dream of repealing it had faded and that Republicans would need to learn to live with Obamacare.

This week, those warnings proved prescient. Republicans failed to land meaningful punches in two congressional hearings that implicated Obamacare. House Republicans on the Energy & Commerce Committee failed to extract any bad news about potential premium spikes from insurance industry executives. Senate Republicans barely attempted to attack the law in a confirmation hearing for Sylvia Mathews Burwell, who'll soon be tasked with leading implementation. Gone are the days when Republicans effortlessly made Democrats squirm over Obamacare and get defensive about its failures.

Things were especially awkward for Florida Gov. Rick Scott (R) last week when he visited a senior center to warn about Obamacare's cuts to Medicare providers and instead found a satisfied group of elderly constituents with few complaints, as reported by the Sun Sentinel.

Although the law will continue to exhibit flaws, Republican pollsters are openly warning that the political landscape has changed. A recent McLaughlin & Associates poll found that thrice as many likely voters want the GOP to produce an Obamacare alternative rather than simply push for repeal.

"The message is clear. Republicans need a popular alternative to replace Obamacare," wrote GOP strategists John McLaughlin and Jim McLaughlin in the National Review.

And that's where things get more worrisome for the party.

There is no replacement plan they can agree on. There are numerous GOP bills to reform certain parts of the health care system but nothing that comes close to an alternative that has sufficient Republican support. That's not because they haven't tried -- it's because the benefits of the Affordable Care Act are unsustainable without the unpopular components that finance them, like the individual mandate. And it is economically infeasible to broaden coverage and protect preexisting conditions without spending lots of money or imposing mandates, neither of which conservative lawmakers are willing to do.

Dean Clancy, a health-policy expert and tea party activist, cautions that Republicans are unlikely to bridge their many intra-party divides on a health care replacement, suggesting that House Majority Leader Eric Cantor (R-VA) may be on a fool's errand to attempt such a feat.

"Maybe Republicans can navigate these treacherous waters. I hope they do," Clancy writes in US News & World Report. "But the smart money is on a crack-up."

Without a plan of their own, Republicans are faced with a choice: campaign on taking away benefits from millions of Americans or give up their repeal quest. Ironically their biggest problem is devising an Obamacare alternative that doesn't look like Obamacare.

"As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act," a congressional Republican health policy aide recently explained to TPM. "To make something like that work, you have to move in the direction of the ACA. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market."