The fight over Obamacare is poised to dominate much of President Trump’s first year in office. Republicans are dead set on following through on years of political attacks against the law. Democrats are equally adamant about saving President Obama’s signature achievement and the millions insured under it.
The problem is that congressional Republicans look increasingly unprepared to follow through on their rhetoric about replacing the law. Yet they and the Trump administration is convinced the law is failing. This leaves the GOP in a real bind.
But there may be a way out. When it comes to Obamacare, the best outcome for everyone may be a stalemate.
As a basic matter of math, Republicans need Democratic support to replace Obamacare. They could repeal the law with a bare majority in the Senate, but will need eight Democrats to go against the party and overcome a filibuster to enact a replacement. Republican leadership, including Trump and House speaker Paul Ryan, has backtracked from the repeal-and-delay misfire, and has since come to promise that repeal and replacement will occur near simultaneously. That requires Democratic votes.
The core question for Trump and the GOP is how to get them. Trump believes that he is negotiating from a position of ever-increasing strength. He thinks the law will crumble on its own, even telling congressional Republicans gathered in Philadelphia that he had thought about “doing nothing [on healthcare] for two years, and the Dems would come begging to do something” after “catastrophic” price increases. Ryan has the same forecast for the law, repeatedly (and falsely) asserting that Obamacare’s individual marketplaces are in a “death spiral.”
Trump has hinted at this scenario before. Earlier in January, Trump tweeted that the GOP needed to “be careful” about repealing Obamacare, because Democrats would be to blame when the law “fall[s] under its own weight.” There is clearly a side of Trump that sees political advantage to continuing to hang Obamacare around the necks of Democrats—a side of him that splits from Republican leadership in Congress on the immediate urgency to erase the law from the books. By sitting back and waiting, Trump suspects he could get a better deal.
Democrats, on the other hand, are confident that Obamacare is succeeding. They point to the 20 million people insured under the law and signs that its marketplaces have stabilized. Democrats are determined to resist GOP repeal efforts, and are increasingly drifting toward a strategy of all-out opposition to Trump across the board.
From the Democrats’ perspective, there’s no reason to disabuse Trump of his notion that Obamacare is a ticking time bomb with their names attached to it. Suppose Democrats stick together as a uniform bloc in opposition to repeal and replace. A frustrated Trump might see the Democrats as “ungrateful” for the GOP’s efforts to save them from their supposed healthcare mess. Trump might then decide to wait until carnage from Obamacare’s “collapse” starts to hit in order to exact a better deal out of desperate Democrats at that time.
For Democrats, this result keeps Obamacare on the books, delaying the repeal fight until a day when Trump may be on even weaker ground in public approval, and a day that is that much closer to the 2018 midterm elections. At that point, Democrats could spark a wave election to take back the House or Senate, stopping Trump’s agenda altogether.
But stalemate-and-delay makes sense for Republicans, too. If Trump gets fed up with congressional gridlock over healthcare and with how much of his first year in office the issue has consumed, he may want to shelve repeal—especially if he expects to pin down the Democrats into agreeing to more favorable terms down the road. But would the repeal-obsessed GOP Congress go along with this? Almost certainly. Trump owns the GOP now, and the party will largely do as he says. If Trump says build a border wall, Ryan asks how high (while writing a $15 billion check, to boot). There’s no reason to think the party would subvert him if he tired of the Obamacare battle.
Trump and other leaders take the position that even though they could wait and let the law implode on its own, they have a duty to come to the rescue of those suffering under the tyranny of Obamacare. By postponing the repeal push, Republicans get to blast obstructionist Democrats for perpetuating the hellish suffering inflicted on the American people under Obamacare.
This relocates the Obamacare debate back into the Republicans’ comfort zone. Republicans are most at ease using healthcare as a political piñata against Democrats. But now that they have the power to decimate Obamacare, they have no plausible plan to put the piñata back together again. At the GOP’s Philadelphia retreat this week, one member of Congress said that the party’s leaders have offered “zero specifics” on an Obamacare replacement so far. A leaked recording of that retreat shows Republican members of Congress ill at ease with the party leadership’s lack of strategy and clarity on healthcare.
So for Republicans in Congress, postponing repeal buys more time to devise a replacement plan, while allowing them to continue to use Obamacare as a political battering ram to rally their base going into the 2018 midterms. Even though they’ve spent seven years railing against the law, Obamacare repeal is a fight that the GOP is not ready for. Republicans are animated by political opposition to Obamacare as an avatar for big government liberalism. But they still aren’t equipped or prepared to translate that political opposition into policy language. Stalemate-and-delay allows them to reap the benefits of the former while avoiding the embarrassment of the latter.
Conversely, it also avoids Republicans taking ownership over the country’s healthcare system going into those elections—something many in the party are loath to do. “We’d better be sure that we’re prepared to live with the market we’ve created” with repeal, said Rep. Tom McClintock of California. “That’s going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.”
There are risks in this gambit for Democrats, but those risks are tolerable. The key is for Democrats to stick together in total opposition to GOP repeal efforts. And they will be sticking together to defend a wounded healthcare law—one that the Trump administration will weaken to the fullest extent of its executive authority. Trump already issued an executive order instructing his administration to relax enforcement of the law “to the maximum extent permitted by law.” White House adviser Kellyanne Conway even suggested the administration may refuse to enforce the law’s controversial individual mandate. And Trump also canceled planned advertising for the law’s individual marketplace plans in the final days of open enrollment in an apparent attempt to reduce sign-ups. These are all attempts to loosen the screws on Obamacare’s three-legged stool.
But these risks were always going to be the case under a Republican administration. Republican sabotage was inevitable, but it beats wiping the law off the books entirely.
So perhaps Obamacare’s future looks much like its past: a political lightning rod perpetually on the chopping block, but never actually chopped. Trump can rationalize stalemate-and-delay as standing pat until a later day when he can bend Democrats to his will. Republicans can keep rallying their base on the promise of repeal were it not for those obstructionist, big government Democrats. And Democrats can appeal to their base having successfully fought Trump and continuing to stand up to Republicans intent on gutting Obama’s signature achievement.
And that might be Obamacare’s political sweet spot. Democrats want to save Obamacare, and Republicans need an off-ramp from repeal. For both parties to win, the solution might just be to stalemate.