John Boehner sat down with Fox News’ Bret Baier yesterday and made a promise: House Republicans will, in this session of Congress, come up with an alternative to the Affordable Care Act. “There are three committee chairmen who have jurisdiction over the healthcare policy in our country,” Boehner said, “and those three chairmen are working together to craft what we believe would be a better approach with regard to healthcare for the American people than Obamacare.” Asked by Baier if there will actually be a bill, Boehner was unequivocal: “There will be an alternative, and you’re going to get to see it.”
If you feel like you’ve heard this before, you’re not wrong. Boehner’s new promise that Republicans will come up with an Obamacare alternative arrived just about one year after his last promise that Republicans will come up with an Obamacare alternative. Speaking to reporters on January 16, 2014, Boehner said the GOP was going to discuss healthcare reform at their annual retreat and “I think you’ll see Republicans come forward with a plan to replace Obamacare.”
Later that same month, then-House majority leader Eric Cantor declared “this year, we will rally around an alternative to Obamacare and pass it on the floor of the House.” By the end of February, Boehner was already backing down and hedging on whether the vote would actually happen. It never did, obviously, and now he’s back to making promises.
Up until now, the notion of a Republican alternative to Obamacare has been largely academic – lacking control of the White House or veto-proof majorities in Congress, they’re in no position to dislodge the Affordable Care Act. However, the question of whether the GOP can finally come through with their own healthcare plan has taken on a bit of real-world urgency now that Obamacare has to survive another Supreme Court challenge.
King v. Burwell will be argued in March and decided sometime this summer, and a ruling against the administration would leave millions of people across dozens of states without health insurance. The ACA would be crippled, and the acrimonious political dynamic between the White House and Republicans in Congress guarantees that there will be no quick-and-easy fix to ameliorate the damage. Normally, Republicans are huge fans of legislative inertia, but in this case the threat of gridlock may actually hurt their chances of seeing the law taken down by the court. The thinking among Republicans and conservatives is that if they demonstrate to the world that they’re ready to step in with legislation to replace the ACA, then the conservatives on the Supreme Court will be more willing to eviscerate the ACA’s health insurance subsidies. Thus you have John Boehner making renewed promises of action on an as-yet undefined piece of post-Obamacare legislation.
But while the urgency is there, the ability is still lacking. Talking Points Memo’s Sahil Kapur has an excellent piece today laying out all the troubles facing the GOP as they work to form something like a consensus on healthcare reform. They’re the same problems that have been dividing the caucus for years now: no one can agree on coverage mandates, whether and how coverage should be subsidized, how to pay for tax credits, etc.
Beyond the policy disagreements, there are political hurdles as well. Anything the GOP comes up with is necessarily going to be less generous than the ACA, which means lots of people are going to lose their coverage and have no way of getting it back. And to the extent that the public has been following the subsidy debate kicked up by King v. Burwell, a strong majority of Americans say they would want Congress to take the path of least resistance and simply restore subsidies to the affected states. There’s likely to be intense pressure on Republicans to step up and help fix the problem, and they’re aware that there’s a steep political price to pay if they can’t.
Now the Republicans have just a few short months to accomplish a hugely complex task that has eluded them for years: coming up with a semi-coherent healthcare reform proposal that doesn’t spark another civil war within the party. John Boehner has promised that they’ll do it, but if the recent past is any predictor, that’s a pretty good sign they won’t.