ground game

The health care debate that no one can win

epa05696715 Members of the 115th session of Congress are sworn into office on the House floor of the U.S. Capitol in Washington, DC, USA, 03 January 2017. Republican Representative from Wisconsin Paul Ryan was reelected as Speaker of the House prior to the mass swearing-in. EPA/JIM LO SCALZO
Jim Lo Scalzo/European Pressphoto Agency
Members of the 115th session of Congress were sworn into office on the House floor on Tuesday.

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Top leaders from both political parties huddled in separate rooms on Capitol Hill Wednesday to discuss the future of the nation’s overriding health care law.

President Barack Obama made a personal visit to Democratic lawmakers, and Vice President-elect Mike Pence did the same with Republican members.

So far, there are no signs that anyone in either of those meetings will be happy.


It’s simple to see why Democrats will be upset. Since the Affordable Care Act was signed into law in 2010, Republicans have vowed to repeal it — or at least big chunks of Obamacare. Now, for the first time since the law was created, Republicans have a majority in Congress who can repeal the law, as well as a GOP president who has vowed to sign off on it.

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As much as Democrats try to game out their political options, it is hard to see how they can save the program wholesale. When Obamacare goes away, they won’t be happy — especially those party members who carried political water on the way to its passage and defended it on the campaign trail afterward.

Republicans may celebrate the repeal of Obamacare, but that is likely when the smiling ends. If Republicans are serious about replacing the law — and Donald Trump has vowed to do this — then there is very little consensus about what a new law would look like.

Here’s the thing: No national Republican, including Trump, ran this year with a big-picture proposal to resolve the country’s health care woes. Yes, there was decades-old talk about buying insurance across state lines, and there was discussion about what parts of Obamacare they could keep (such as insurance for those with preexisting conditions).

But Trump has not laid out a specific plan. US House Speaker Paul Ryan has talked about universal access to coverage instead of universal coverage, but it is unclear what that looks like or how much support it has in the US House or Senate. There are some, for example, who don’t want any replacement law because they fear it will blow up the budget.


Republicans are in control now — so they can give themselves more time to figure out the details. The talk in Washington is that even if Republicans move quickly to repeal the law, it wouldn’t actually be phased out for some time. One idea is to have the law expire in two years. Another is that it will be gone in three years.

But at the moment, the GOP-controlled House and Senate cannot agree on that. Some members say they want an even faster rollback process, landing well before the two-year mark, when many of them will be seeking reelection.

But hey, if you like your Congress, you can keep it, right?

James Pindell can be reached at james.pindell@globe.com. Follow him on Twitter @jamespindell, or subscribe to his Ground Game newsletter on politics: www.bostonglobe.com/groundgame.