WASHINGTON — On March 23, 2010, Barack Obama inked his presidential signature on legislation to transform the country’s health care system, while a furious Republican Party vowed to repeal and replace it with a plan of their own.
Five years later, after more than 50 House votes to dismantle the law, and with some 16 million people newly insured under the Obamacare regime, the GOP has come up short on a replacement proposal that it can rally around.
“Committees are continuing to work on that and I’m sure we’re gonna see one soon,” House Speaker John Boehner (R-OH) told reporters on Thursday when asked if there’s a Republican replacement to Obamacare.
“How soon?” a reporter pressed.
“I think we’ll see one soon,” the Speaker reiterated.
“One that covers 16 million people?”
Boehner didn’t answer. He quickly moved on.
Understandably so: It’s a topic Republicans don’t like to discuss. Boehner could have made those remarks any day during the last five years. GOP leaders have been steadfast in promising an alternative they can get behind — at least 20 times since 2010 — sometimes insisting that it’s right around the corner. But it doesn’t appear. The House and Senate GOP budget proposals unveiled last week called for repealing and replacing Obamacare but didn’t propose a specific health care reform plan.
There’s greater urgency for a Republican plan now than ever. The Supreme Court is poised to decide a case by the end of June that could destroy a centerpiece of Obamacare — insurance subsidies in some three-dozen states. Such a decision could cripple the law, cause millions of Americans to lose their coverage and damage insurance markets in many states.
Republicans have endorsed the lawsuit, and are working to convey to the Supreme Court that they’ll be ready to act if the subsidies are erased. A House-passed bill to repeal Obamacare in February instructed the committees of jurisdiction to write an alternative. Ditto for Senate committees in the chamber’s Republican budget proposal, which imposes a deadline of July 31.
It’s doubtful that much will come of it. There are two key reasons Republicans have failed to propose an replacement. The first is that the sorts of tradeoffs required to help the uninsured traditionally include ideas that are ideologically anathema to conservatives: taxes, spending and regulations. The second is that they haven’t been able to devise a more market-friendly way than Obamacare to expand coverage — no country or state has pulled off this feat; Massachusetts achieved near-universal coverage with an Obamacare-like system. Republicans recognize that it’s politically perilous to defend the prospect of Americans losing their insurance.
“That’s the brutal truth. We have a problem with that for very specific reasons. Show me the constituent in a town hall meeting who you can tell it’s OK for them to lose their health insurance,” a congressional Republican health policy aide, who requested anonymity to speak candidly, said recently.
Many conservatives are less concerned with expanding the ranks of the uninsured, but they broadly agree that insurers shouldn’t be able to deny coverage to people with pre-existing conditions. Here, too, Republicans run into a problem: It’s unsustainable to guarantee coverage without a mechanism to bring young and healthy people into the system, health economists say. Obamacare achieves that with an individual mandate, which conservatives despise.
There are a variety of bills proposed by Republican lawmakers, which would mostly tear down regulations and make conservative-backed changes like imposing caps on malpractice damage awards, letting insurers sell across state lines and enhancing tax incentives for health savings accounts. But none have much support within the party or the endorsement of leaders. Even House Budget Chairman Tom Price (R-GA) a physician who has a health care bill of his own, has failed to gain much support from his own members.
“We all have our own opinions about these things,” House Ways & Means Chairman Paul Ryan (R-WI) told reporters last month, regarding a Republican health care solution. “Everybody’s got their own ideas.”
Proposing a plan would expose the party by forcing them to either endorse the subsidies and mandates needed to cover the uninsured, or to propose an approach that satisfies the base but which the Congressional Budget Office would likely say increases the ranks of the uninsured. That conundrum remains, and Republicans haven’t been able to find a way out of it.
And if that wasn’t enough, there’s another strong political incentive not to offer a replacement plan. The 2016 elections are approaching, and any such plan would box in the party’s presidential nominee (or risk the embarrassment of being rejected by him).
“Common sense tells me that you don’t want to do anything between now and the November elections to screw things up for the next presidential candidate,” Sen. Chuck Grassley (R-IA) told the National Review, a conservative magazine.