Despite the blowback from conservatives, who want nothing less than to wipe out the law in its entirety, top Senate Republicans are signaling that they're behind the strategy of resurrecting some aspects of the Affordable Care Act.
Sen. Roy Blunt (MO), vice chair of the Senate GOP Conference, offered a ringing defense of the "Obamacare" under-26 provision, and said he wouldn't oppose ideas he previously supported simply because President Obama adopted them.
"I believe that's one of the things that the Congress would surely reinstate," Blunt told the St. Louis radio station KTRS in an interview last Thursday, pointing out that he has offered similar legislation in the past. "It's a way to get a significant number of the uninsured into an insurance group without much cost. ... It's one of the things I think should continue."
"I've been in a couple meetings lately and there's some general understanding that that's one of the things ... and there are other things like that as well," the senator added.
A GOP health aide explained the strategy on the shift: "Come up with a plan and come up with a plan quick to deal with popular ... provisions. An interesting twist will be money spent and continued implementation. There could be a deal struck on those two issues as well." The aide said Democrats would have a hard time turning down a Republican proposal to reinstate some of the law's most popular pieces.
Sen. Lamar Alexander (TN), asked by TPM if he believes his party should back the pre-existing conditions and under-26 laws, didn't endorse specifics but affirmed that his party ought to have a plan ready. "Well, I think we need to be prepared," he said. "And we will be prepared."
The shift is notable because Republicans have spent more than two years pledging nothing less than total repeal of the law. That has conscripted them into disavowing all of its elements, implicitly or explicitly, even though core pillars of the law had significant support within the GOP before Obama embraced them.
Now, however, the party would be caught in an election-year predicament if the Supreme Court grants them their wish and overturns the law. Warming to these provisions is an important signal that Republicans believe the extent of their anti-"Obamacare" stance over the last few years is politically unsustainable. That's not sitting well with conservative advocates.
The deeper problem with the GOP's fall-back plan is that guaranteeing coverage regardless of pre-existing conditions is economically infeasible without a requirement, like the "Obamacare" individual mandate, to bring young and healthy people into the insurance system. It addresses the need to spread risk and prevent costs from spiraling upward.
On KTRS, Blunt floated the idea of high-risk pools to cover pre-existing conditions -- an idea that presents its own adverse-selection quandary -- and discussed the broader systemic problem in remarkably similar terms as Obama and his allies have done in their defense of the Affordable Care Act's individual mandate.
"You know, you do run a risk when you decide you're not going to have insurance," Blunt said. "And a lot of those -- that odd, that occasional young person who believes they're not going to need health care, doesn't get it, and then they have a terrible accident or they have a unique illness that most young people don't have. These high risk pools give them somewhere to go that is somewhere close to normal insurance."
Some Democrats think the Republican shift is merely a bluff.
"They're joking, right? This is serious?" Sen. Sherrod Brown (D-OH) told TPM. "The Republicans -- the tea party has never been for consumer laws, never been for protecting families, never been for making Medicare work better. So it's a continued sham."