For Dems, Successfully Blocking ACA Repeal Means Crippling GOP Agenda

It looks like Trump and the GOP are betting the ranch on Obamacare repeal. The Wall Street Journal is reporting the Congressional GOP leaders are going to take a "now or never" approach to Obamacare repeal, essentially daring their GOP members to vote against a bill that would repeal most of the major elements of the ACA. There will be no replacement plan offered, although the bill may include a transition period and the expansion of health savings accounts. If the GOP can push through the repeal on a party line vote under a budget reconciliation that requires only 50 votes in the Senate, they will then try to pass some legislation later to build their replacement plan. But the replacement plan would require 60 votes to pass in the Senate, meaning they would have to bring along some Democratic votes, and even that assumes those bills can clear the divided House. That seems highly unlikely in the present environment. And all that assumes that health insurers don't withdraw en masse from the exchanges when they see repeal with no replacement as the GOP strategy.

It also seems like an enormously dangerous strategy for Republicans. Their members have been overwhelmed over last week's recess with constituents either demanding the ACA stay in place or that the GOP reveal a detailed replacement plan. In addition, Trump said explicitly on the campaign trail that the his replacement plan would cover everyone who now has insurance but do it for less money. His administration is now backing away from that pledge. Today, he made the extraordinary admission of ignorance that "Nobody knew that health care could be so complicated. I have to tell you, it's an unbelievably complex subject."

More importantly, Trump has signaled that tax reform is off the table until repealing the ACA can be completed. In remarks today, Trump said, “I can’t do it [tax reform] until we do health care, because we have to know what the health care is going to cost and — statutorily — that’s the way it is. So for those people who say, ‘oh, gee, I wish we could do the tax first,’ it just doesn’t work that way. I would like to do the tax first." The reality is that there is nothing stopping Trump and the GOP from tackling tax reform first. The reason that they don't has nothing to do with statutory rules. It is because the 2011 sequester agreement means that tax reform has to be revenue-neutral. The only way for the GOP to cut taxes on the rich, which is their overriding goal, is to repeal the taxes on the wealthy that are used to fund the ACA.  The tax cuts they desire will not really come from tax reform but from repealing the ACA and the taxes associated with it. In essence, repealing the ACA is the lynchpin of the entire Republican legislative strategy.

So the battle lines are clear for Democrats. If we can stop the repeal of the ACA in its tracks, we can stop much of the GOP legislative agenda. That means that the level of resistance and pressure on those GOP House members and Senators must be maintained and perhaps even intensified on the coming weeks. It is only that relentless resistance that will scare enough Republicans in Congress from pulling the plug on Obamacare when they know there is and never will be an adequate replacement plan. We should look on last week as just the beginning of the battle, an opening warning shot. If we can sway enough Republicans, the major elements of the unpopular GOP agenda will also be crippled.