When Republicans repeal major components of Obamacare in January, they are going to need Senate Democrats to help them replace it.
While incoming Senate Minority Leader Chuck Schumer (D-NY) has been emphatic that Democrats won’t be helping Republicans pick up the pieces after Obamacare repeal, red state Senate Democrats are the ones who will decide the ultimate fate of Republicans’ repeal gamble.
As of now, Senate Democrats who will be running in states Trump easily won are holding the line.
“What’s the replace bill look like? You don’t know. They don’t know. There isn’t one so if they repeal Obamacare, they’ve got to explain to 700,000 Ohioans why they lost insurance, they’ve got to explain to seniors why they’re losing close to $1,000 a year on their drug benefits,” Sen. Sherrod Brown (D-OH) said.
What about when Republicans start pressuring Democrats?
“They can pressure all they want. What does pressure mean? That they’re going to repeal and they say ‘fix it?'” Brown said. “They’re going to have to explain why they’re doing what they’re doing. My re-election has nothing to do with that.”
Senate Democrats in 2018 have one of their toughest maps in years. Up for re-election are senators in states like North Dakota, Montana, Indiana, Missouri and West Virginia – states that are solidly red. That does not include states like Pennsylvania and Wisconsin, where Trump’s surprise victories are making Democrats think twice about their home states’ politics.
On health care, however, red state Democrats may not be willing to budge. While helping Republicans come up with a replacement plan might show they’re flexible, bipartisan and putting their constituents ahead of politics, it also neutralizes what could become the best line of attack they could have against Republicans in the midterms if the GOP plan is either still not finished or is politically unpopular.
Right now, Republicans’ plan is to repeal Obamacare as soon as possible and then give themselves two or three years to transition away from it and onto an undetermined replace plan. Most experts TPM has spoken to that Republicans could do some pieces of a replacement plan through reconciliation – which requires only 51 Senate votes–but at the end of the day Sen. Lamar Alexander (R-TN), who chairs the Health, Education, Labor and Pensions Committee, has told TPM Democrats will need to come on board.
Health policy experts have warned that repealing Obamacare without a replacement could send the insurance market into a tailspin. The Urban Institute released a study Wednesday predicting that 30 million people could lose insurance. Health care experts across the board have warned that repealing the Affordable Care Act along with the individual mandate would lead to a large number of individuals pulling out of the market because they were no longer required to be insured. As a result, the only people left would be the sick who would experience major hikes in insurance premiums.
Republicans are counting on the fact that if the doomsday scenario comes true they will be able to pressure red state and swing state Democrats to come to the table and work on a bipartisan replacement.
“When that date came and you did nothing, if you want to play politics, I think the blame would go to people who didn’t want to do anything,” said House Majority Leader Kevin McCarthy (R-CA) in a pen and pad with reporters earlier this month.
Democrats, however, view Republicans as the ones playing politics with the issue. After six years of being on the defensive about Obamacare, Democrats could find themselves in a position to criticize Republicans for failing on health care.
“Our position is you guys have had seven years since March of 2010 when you said you needed something else. You’re not willing to talk about a replacement yet?” said Sen. Tim Kaine (D-VA). “If they came to us and said we would like to talk to you about something, and we’ll call it replacement and you’ll call it reform, we would sit and talk, but if it starts with repeal, they’re telling us they don’t want us involved.”
Sen. Heidi Heitkamp (D-ND) is considered one of the most vulnerable senators up for re-election in November 2018. Trump won her state by more than 35 percentage points. Heitkamp was vague when asked whether she’d sit down with Republicans and deal on Obamacare.
“What I plan on doing is making sure we don’t have chaos in health care,” Heitkamps aid.
One indication of where senators might land on Republican health care alternatives might lie in how they are responding already to changes Republicans plan to make on Medicare.
After House Speaker Paul Ryan (R-WI) told Fox News that he was interested in privatizing Medicare, Sen. Joe Donnelly (D-IN) came out strongly against such an idea.
“I will oppose any effort to privatize Medicare or turn it into a voucher program in the future,” Donnelly said. “If my colleagues have pragmatic ideas that strengthen Medicare … count me in, but if they want to phase out Medicare, or privatize the system, count me out.”
Donnelly has also announced that he plans to vote against Rep. Tom Price (R-GA) to be the secretary of Health and Human Services because of Price’s support for Medicare privatization.
One red state Democrat Sen. Claire McCaskill (D-MO) wouldn’t weigh in on what’s to come, but said she’s not confident Republicans will be worth working with if they continue to put repeal ahead of replace.
“You can’t repeal it until we know exactly what you’re going to replace it with and when that is going to go into effect,” McCaskill said.