One of Donald Trump’s signature promises during the Presidential campaign was to repeal the Affordable Care Act (known as Obamacare) on “day one” of his Presidency. Vice President Mike Pence echoed this in early January, saying it would be “the first order of business.” House Speaker Paul Ryan promised that it was a “first priority” for the new Congress.
That was then. This is now.
Both the Trump White House and the Republican-controlled Congress have admitted that the ACA is not going to be repealed anytime soon. Maybe not for years. If ever. Here’s why:
First, Republicans are afraid to simply repeal the ACA because that would result in 20-30 million American families abruptly losing their current health insurance, with no prospect for replacing it with anything even remotely comparable or affordable. They are right to be afraid. Twenty million angry voters, many of whom are Trump supporters, is a frightening thought.
Second, President Trump does not have anything to replace the ACA with. He claimed he did all the way through his campaign, but it was just talk. He has no plan and never did. This is mainly because health care insurance is an incredibly complex issue, and Trump and Company never bothered to think it through beyond broad generalities. Now he is realizing that, as always, the devil is in the details, and that this is an especially devilish problem.
Third, the Republicans in Congress HAVE thought about health care insurance. They’ve been thinking about it ever since the ACA became law, and they do have some ideas. But they have been unable to agree amongst themselves about what to replace the ACA with. Again, the problem is that it is really, really complicated stuff, with lots of unintended and unexpected consequences if you don’t get it right, as demonstrated by some of the less desirable results of the ACA itself.
Republicans have now pretty much stopped talking about “repeal” and are more likely to use the word “repair,” meaning that they recognize that a good deal of what is in the ACA is there because there are only so many ways to do it. Congressional Republicans are positioning themselves to do what Obama repeatedly asked them to do all along: keep what’s good, fix what’s bad. Of course, Republicans wanted nothing to do with that at the time, but it’s their baby now, so they have to do something.
Republicans in Congress have been railing against the ACA for most of Obama’s time in the White House. Now it’s time to put up or shut up, and it is becoming painfully obvious that they don’t have anything to put up. The usual thing politicians do when this sort of thing happens is to execute some sort of political sleight of hand that lets them claim to have done something when in fact they haven’t done anything at all. Republicans do not have a monopoly on this tactic.
My prediction: One of two things will happen. Either Trumpcare will end up looking a lot like Obamacare, with the names changed to protect the guilty. Or Trumpcare will end up looking a lot like what we had before the ACA, but with some pretty-sounding buzzwords, like “Health Savings Accounts,” thrown in to fool people into believing Congress has actually done something when if fact it will leave most Americans without useful and affordable insurance.