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Michael A. Cohen

The GOP’s Obamacare replacement plan fantasy

House Speaker Paul Ryan, accompanied by House majority leader Kevin McCarthy, met with reporters on Capitol Hill on Tuesday to discuss efforts to replace the Affordable Care Act, following a closed-door meeting with the GOP caucus.
House Speaker Paul Ryan, accompanied by House majority leader Kevin McCarthy, met with reporters on Capitol Hill on Tuesday to discuss efforts to replace the Affordable Care Act, following a closed-door meeting with the GOP caucus.(J. Scott Applewhite/AP

Santa Claus, the Abominable Snowman, the Easter Bunny, the Loch Ness Monster . . . and the Republican Party’s replacement plan for Obamacare. What do all of these have in common? They don’t exist, and they never will.

Like these mythical creatures, a Republican health care plan has become folklore in the strange netherworld called Capitol Hill. There, a replacement plan is the fairy-tale alternative to the evil Obamacare — the health care plan Republicans hate with a passion and have pledged to repeal. But this is what it’s like to live in fantasy world: believing unusual things that ordinary people know aren’t true.


As Republicans have increasingly come to the uncomfortable realization that taking away health care coverage from as many as 30 million people could be a threat to their very existence (i.e., their political careers), they have begun searching desperately for a magical solution. There was talk of delay or subsidizing insurance companies, and now odd creatures, with peculiar names like Corker, Portman, Collins, Cassidy, and Murkowski have asked their leader (the one they call McConnell) to delay repeal for a few weeks so a replacement plan can be identified.

According to Corker, “You would think that after six years we would have a pretty good sense of what we would like to do.” In a non-bizarro world, one would think that. But the Republican-controlled Capitol Hill has for six years been a magical place where logic, facts, and real world impact of policy choices dare not tread.

Indeed, from literally the moment that the Affordable Care Act was signed into law, Republicans pledged to repeal it. Even as the bill expanded coverage to more than 20 million Americans, reduced the once seemingly inexorable rise in health care spending, and brought new efficiencies and better health outcomes, the Republican mantra on Obamacare never changed — It’s The Worst Thing Ever.


And while they were the opposition party, Republicans could dance about and throw stones from afar without any fear that they’d have to find an alternative. But such luxuries don’t exist for those now suddenly in charge. If Republicans repeal Obamacare they will own American health care. The problem, however, is that the fantastical orthodoxies of modern Republicanism don’t line up with the realities of the American health care system.

If the government won’t subsidize the health care needs of poor and middle-class workers with billions in government spending — either with tax credits or federal spending for Medicaid — they won’t be able to afford insurance. If the government won’t mandate that healthy people buy insurance, there’s no way to create a risk pool that will make it worthwhile for insurers to offer care in the individual health care market. Not only would millions lose care, but those wealthy enough to afford coverage would likely face far higher deductibles and ever-rising premiums.

From a political perspective, even if the GOP could pass such a plan in the House, it would never pass muster with the reality-based Senate Democrats — who have every reason to follow the age-old advice that if your opponents are digging a hole, hand them a shovel. There is zero political incentive for Democrats to go along with a replacement bill that is not Obamacare or better. So a Senate filibuster is inevitable. Even if Republicans do come up with a replacement plan, the chances of passing it are about as likely as unicorns racing down Pennsylvania Ave.


Oddly, this could play to the GOP’s political benefit: They could claim that the enchanted replacement plan that will be so terrific it will make your head spin is being blocked by the big bad Democrats.

Unfortunately for Republicans, they could repeal broad swaths of Obamacare, though not all of it, via the budget reconciliation process, which requires only 51 votes — and their most rabid supporters expect them to do that. But partial repeal that keeps in place Obamacare regulations but not the spending to maintain the program is a recipe for a long, drawn-out political catastrophe in which the individual health care marketplace slowly collapses. Republicans would find themselves under ever-increasing pressure to fix a problem they created.

For Republicans, there is no happy ending to this story. If they don’t repeal Obamacare, they infuriate their supporters; if they do repeal it, they infuriate everyone else. But considering that polling shows even hinterland-dwelling Republicans like the individual aspects of Obamacare, the choice should be an easy one. The question now for the Republican Party is whether they’ll be able to separate fantasy from reality.

Michael A. Cohen’s column appears regularly in the Globe. Follow him on Twitter @speechboy71.