As the energy and enthusiasm for “repealing and replacing” the Affordable Care Act gains momentum among congressional Republicans, it’s worth pointing out as many times as possible that Republicans do not have a replacement plan. They are not close to having a replacement plan. And they can’t even agree on the basics of what a replacement plan should look like.
This is not a new development. It has been the defining feature of the Republican health care policy discussion ever since the ACA was passed nearly seven years ago. Republican leaders in Congress have promised several times since 2010 that they were going to pull together and produce a consensus piece of health insurance legislation as an alternative to the Affordable Care Act. Every one of those promises has been broken.
For a long time that didn’t really matter because Republicans were not in a position to follow through on their threats against the ACA. But now all their broken promises are catching up to them as they find themselves on the cusp of being empowered to make good on their “repeal and replace” mantra.
Clearly sensitive to the fraught politics at play here, Senate Majority Leader Mitch McConnell wrote a Fox News op-ed to reassure people that everything will be OK when Republicans charge forward with repealing the health law without anything to put in its place. But what McConnell’s op-ed really shows is that Republicans don’t even have a coherent message on health care, let alone a policy.
Here’s how McConnell kicks off his piece:
By nearly any measure, ObamaCare has failed: It didn’t lower costs, it didn’t increase choice, middle-class families continue to lose health plans they were promised they could keep, and Americans continue to call for ObamaCare’s repeal.
They spoke loudly again this November, and about 8 out of 10 favor changing ObamaCare significantly or replacing it altogether.
We in Congress hear you, and we have already begun to act.
The Senate is currently working to pass the legislative tools to bring relief to the middle class by repealing this partisan law.
His message is clear: The Affordable Care Act has failed, and its failure has destroyed American lives and damn near ruined the country. The evidence he marshals to support is message is false: People signed up for Obamacare in droves following the election and 75 percent of the country opposes McConnell's plan to repeal Obamacare without a replacement ready. That disconnect partly explains why McConnell has pivoted to this flatly self-contradictory argument about why he and the rest of the GOP Congress are moving so quickly to repeal:
We’re acting quickly because ObamaCare is collapsing under its own weight, and things will continue to get worse otherwise. That doesn’t mean the law will end overnight. There will be a stable transition period, and once repeal is passed we will turn to replacement policies that cost less and work better than what we have now.
So, see if you can follow the logic. Obamacare is bad, and it’s so bad that it has to go immediately or it will get worse. But don’t worry: It won’t actually go way immediately. There will be a “transition” period during which somehow it won’t get worse! McConnell has to kill the law immediately because it is collapsing, but he also won’t kill it immediately because of the danger of collapse.
If that sounds confusing, I apologize, but believe me it’s not my fault.
That brings us to this confounding passage:
Some contend that, by fulfilling our promise to the American people, we're somehow trying to go back to the way things were before ObamaCare — which we all know is untrue (it's worth remembering that things are now worse for many than they were before ObamaCare). Some say repeal will cause insurers to flee the exchanges (which is happening already, thanks to ObamaCare) or say it will plunge ObamaCare into a death spiral (which, in case any have missed, is here already . . . and quickly approaching terminal velocity). Others will try to claim the failure of ObamaCare as a mandate for even more ObamaCare — which makes about as much sense as it sounds.
I’m completely baffled. The gentleman from Kentucky is arguing all the bad things that people say could happen if Republicans move too quickly with repeal are already happening — but also that Republicans can’t just end the law because they don’t want to go back to the pre-Obamacare status quo, even though “things are now worse for many than they were before ObamaCare.” If the Obamacare “death spiral” is “quickly approaching terminal velocity,” then why is McConnell reassuring us that the law will be left in place to achieve that “death spiral” while he and his colleagues figure out what the hell comes next?
McConnell’s chief deputy, Majority Whip John Cornyn, R-Texas, said last month that the “transition” period for Obamacare would be three years. Will the terminal-velocity death spiral not arrive before then? How will the “transition” be made “stable,” as McConnell wrote? What the hell does any of this mean?
It means that McConnell and his colleagues are trying to have it both ways by promising voters that they’re saving them by killing Obamacare immediately but also granting them a reprieve by delaying its death for the foreseeable future. It’s a message that makes no sense and is at open war with itself, and this incoherence doesn’t bode well for the Republican push to actually — someday!— create health care legislation.