Republicans would be sorely mistaken if they try to patch up Obamacare rather than repeal it. You don’t pour money into propping up a condemned, collapsing house just because you like the large flat-screen TV. Similarly, you don’t keep the sprawling 1,000+ pages of the ACA, with all of its spin-off regulations, just because you like the ability to keep your kids on your health insurance until they’re 26.
Obamacare is so large, complex, and filled with exceptions, exemptions, and contradictions that many of its unintended consequences are yet to be felt. As noted by Scott Gottlieb, MD, a resident fellow at the American Enterprise Institute, a member of the Federal Health IT Policy Committee, and an assistant clinical professor at New York University School of Medicine in New York City, a future president could enact universal socialized medicine without congressional approval based solely on Section 1332 in the ACA (Wall Street Journal. Sept. 13, 2016. Available at wsj.com/articles/clintons-stealthy-single-payer-gambit-1473808428). Could this be why some politicians want to fix, not repeal, Obamacare?
Could it be that the GOP likes to have Obamacare around as a whipping boy during election time? Well, that will only last so long. In fact, Trump’s election can be viewed as a repudiation of GOP grandstanding on Obamacare without getting any results. After two successive elections that resulted in a Republican majority in the Senate and the House but nothing to show for it, the Republican faithful are losing faith and patience.
The Likely Fate of Obamacare
The 2016 election has won the presidency for the GOP and maintained majorities in the Senate and the House; however, unlike Obamacare’s passage with a Democrat supermajority in the Senate, the Republicans still do not have a 60-vote majority in the Senate and will not be able to force a repeal of Obamacare without Democrat support. A more likely option would be for the GOP to move for defunding many parts of Obamacare through the process of reconciliation, which only requires a simple majority vote in the Senate. While this is an effective means of removing most of the ACA, it will take time.
The Obamacare exchanges are crumbling and may fail even before a repeal. Nearly three-fourths of the exchanges have already gone bankrupt, and many major insurers have left the market entirely. So, a crisis of health insurance may actually precede any actual action taken by Congress and the Trump administration.