ObamaCare: What Can a Republican President Do About It in 2017?

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Commentary Magazine:

From the time of its inception until the end of June of this year, the Affordable Care Act had been riven with uncertainty about whether it would pass, what would happen to it in a Republican-led Congress or with a President Romney, and whether it would survive judicial scrutiny. But when the next president enters office in 2017, he or she will have to deal with the stark fact of its existence. The Supreme Court ended any hope of its destruction before Obama’s departure from office when it chose to uphold the “intent” of the law in King v. Burwell at the end of its 2015 term—rather than ruling that federal subsidies to states that have not set up their own health-care exchanges were a clear violation of the language of the statute. There will be no visitation from above to save America from ObamaCare. The ACA appears fairly ensconced. It is not a success, and it remains unpopular, but there it is, and there, for now, it will stay—and the various players in the U.S. health-care system are trying to work through, or perhaps more accurately, around, it to get things done.

 

The GOP primary battles will help select a standard-bearer who can champion and rally support for a single plan that the party can finally call its own.This means the election of 2016 will surely constitute the Republican Party’s last real chance to make significant changes to or even repeal the Affordable Care Act. For this to happen, a Republican would have to win the White House and, in the process, make an eloquent case regarding the problems created by the legislation while offering a reasonable, actionable, and workable alternative. The candidate will have to explain all this to the American people without appearing to be a grinch seizing benefits from those in need. And even that will not be sufficient. If a Republican becomes president, the configuration of the two Houses of Congress will matter enormously. Will Republicans retain majorities in both the House and the Senate? How big will the majorities be? Might there be enough Republicans, coupled with the increasingly rare breed of conservative or even moderate Democrats, to form some kind of filibuster-proof coalition in the Senate that will allow an anti-ObamaCare bill to move to the floor for a vote?

Due to these uncertainties, this Republican president would need a slate of proposals that could be pursued under almost any scenario. While running for office, he or she would need to lay the groundwork to press forward a mandate that could work in the various political configurations of Washington. A Republican candidate who wants to win the primaries will have to advocate outright repeal of ObamaCare. But to win the general election, he must also have a plan that can be acted upon if repeal proves impossible to attain in 2017—even if the new president goes for it anyway and fails.

 

Republicans have long been accused of not having alternatives to the ACA, but in truth, if anything, Republicans and conservatives have designed and proposed too many plans to replace ObamaCare. This makes it extremely difficult for Republicans to unite behind a single plan. Fortunately, the primary battles will help select a standard-bearer who can champion and rally support for a single plan that the party can finally call its own.

 

The candidates, and eventually the new president, will have to properly define the ObamaCare problem. In designing the Affordable Care Act, the Obama administration tried to lasso the moon—to bend the cost curve down while providing universal insurance coverage at the same time. In doing so, the president highlighted the number of people who were uninsured at any point throughout the year, a figure that ranged between 30 million and 46 million.