The GOP’s Obamacare cliff is closer than they want you to believe

During the budget wars of the Obama administration, congressional Republicans regularly courted national disaster by forcing fiscal cliffs, debt cliffs, and austerity cliffs on the country.  Now in control of Washington, Republicans look poised to set up an Obamacare cliff.  This might be the most reckless act of GOP gamesmanship yet.

When it comes to Obamacare, the GOP is the dog that caught the car.  Republicans have railed against the law for years, voting to repeal it 60 times and shutting down the government in protest.  But now that they are in power, Republicans are finding themselves utterly ill equipped to take action against the law.  That’s because they still haven’t yet readied a nuts-and-bolts health reform plan over the last six years.  Even though “repeal and replace” has long been their rallying cry, conservatives have spent precious little time forging a unified strategy for the latter part.

Aside from policy considerations, “repeal” also has a simpler legislative path than does “replace.”  The GOP can repeal most of the law through a reconciliation bill on a bare-majority vote, meaning without Democratic cooperation.  To affirmatively pass a replacement law, however, Republicans will need Democratic votes, unless they kill the filibuster (which some key Republican senators are reluctant to do).

This combination of policy uncertainty and political expediency is pushing the GOP toward a strategy of quickly repealing the law on a time delay.  Without a readily available replacement, Republicans will try to repeal the law while postponing its actual demise until perhaps January 2019, after the 2018 midterm elections.  This would ostensibly give Congress two years to devise a replacement for the law, extending Obamacare a two-year fuse until it explodes.

GOP health policy expert James Capretta objects to this strategy on the grounds that Congress will wind up perpetually extending Obamacare’s two-year lifeline.  “If . . . the GOP sticks with a repeal-only bill,” Capretta argues, “there is a high probability that they will never get around to agreeing on a workable replacement plan. At which point the odds would then favor retention of the ACA, or something close to it, as the only viable way forward.”

Capretta points out that legislative momentum will only wane after 2017 and into 2018.  The likelihood of an Obamacare replacement doesn’t increase over time, but dwindles by the day.

Keeping Obamacare on the books may be the conservative nightmare scenario.  But the other consequences of the GOP’s reckless repeal-and-delay course are far more dire.  For one thing, the mere contemplation of repeal, let alone actually passing a repeal bill, may be enough to create an insurer stampede out of the law’s marketplaces.  Insurers must decide whether to offer plans for 2018 in the marketplaces before May 2017, just three months into the new Congress.  Many will be unlikely to participate in a program that is in the midst of being slowly killed off.  This is particularly true given the already fragile state of the exchanges, which are in need of constructive reform, including previous wounds inflicted by the GOP to strip the law’s protections for participating insurers.  If insurers flee a perceived sinking ship, the law will cease to function whether it’s officially repealed or not.

If the GOP forges ahead with repeal-and-delay and triggers an insurer exodus in the process, there very well may not be any can to kick down the road again come January 2019.  The law could become zombie health reform with impotent, ghost-town marketplaces.  There would be nothing left for Congress to extend.

So the GOP likely cannot reap the political benefits of repeal while putting off the tangible costs for two years.  And those costs would be very real.  The private insurance markets in all fifty states could seize up, making it functionally impossible for the millions of people who currently rely on Obamacare’s exchanges today to obtain coverage.  The historic gains we’ve made in expanding insurance would quickly reverse.  Repeal-and-delay would take a massive human toll.

So if the exchanges are mostly bled dry by Republicans before January 2019, what then?  Once the GOP lights this fuse, the rapid deterioration on insurance markets would probably place immense pressure on Democrats to cooperate with right-leaning reform efforts.  And if the 2018 midterm elections become a backlash against Trump and restore Democrats to power in Congress, then Democrats would be left to clean up the healthcare mess that the GOP is about to create.

The GOP’s repeal-and-delay strategy is ostensibly meant to buy Republicans time to devise a substitute to center-left health reform.  But it’s hard to see what Republicans will be able to dream up in two years that they couldn’t in six.

Setting up an Obamacare cliff once again triggers a high-stakes game of chicken.  But unlike previous congressional chicken matches, blinking at the last hour might not spare the harm this time.  Rather, because Obamacare relies on private health insurers to expand coverage (i.e., because Obamacare is a centrist attempt at universal healthcare), the harm of repeal may be realized well before Congress even has a chance to flirt with plunging over any self-concocted cliff.

So Republicans pushing repeal and Democrats opposing it need to understand that “repeal and delay” is functionally no different than straight-up repeal .  Delay does not postpone the fight for another day.  When that day comes, it will already be too late — the law’s foundations will already be drastically weakened, perhaps entirely moribund.

Republicans are trying to set up yet another cliff to force congressional action.  But the cliff is much, much closer than it might appear.  The question is who truly realizes it.

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