“So the dog finally caught the car.” That seemed to be the consensus in Washington Wednesday after Vice President-elect Mike Pence and congressional Republicans declared with confidence that they will begin to repeal Obamacare immediately, but struggled to say what Americans could expect as a replacement for the president’s signature health care law, or when.
“It will literally begin on Day One,” Pence promised in a press conference about President-elect Donald Trump’s plans for dismantling Obamacare. But when asked what exactly will happen on Day One, or what the House will eventually vote on, Pence and House Speaker Paul Ryan declined to go into detail.
In another room in the Capitol that same day, President Obama had his own competing message to congressional Democrats. “Don’t rescue Republicans,” he said, counseling them to refuse to help replace the legislation with something he believes will be inferior.
The reality is that Republicans will need a rescue from Democrats to keep their “repeal and replace” campaign promise. Even though they’ll need just 50 votes in the Senate to strike much of the law, they’ll need 60 votes, including eight Democrats, to put anything else in its place.
As of now, it doesn’t look like that’s going to happen. “They need 60 votes to replace the ACA and Democrats won’t help with replacement,” a Democratic leadership aide told me.
The pitfalls for Republicans here are obvious — they spent the last seven years grousing about a policy they have no consensus or ability to replace. If a bipartisan solution were easy or obvious, they would have come up with it by now. But they’re barreling forward to repeal it anyway, and to Nancy Pelosi’s point — the Pottery Barn rule is in play here. When the Republicans break Obamacare and potentially the health care system it’s embedded in, they’ll own the result. And if the experts are to be believed, it won’t be pretty.
A report circulating on the Hill from the Urban Institute sketches out what a partial repeal through reconciliation will look like. First, the group predicts, nearly 30 million Americans now covered through the underlying legislation will lose their health insurance. That’s projected to drain $145 billion in health care spending away from health care providers in 2019 alone. Even without coverage, some uninsured people will have to seek health care, and the cost of that care will fall to providers and to the federal and local governments. And things will get worse from there.
Pence and Ryan promised Wednesday that they will give Americans now covered “an orderly transition” to new health insurance coverage. But without Democratic votes for a replacement, Republicans will be transitioning those Americans to nothing, another bridge to nowhere that Congress is so good at building.
But as precarious as the situation is for Republicans, there is danger here for Democrats, too. At some point, they will have to decide whether voting for relief for Americans displaced from Obamacare is rescuing Republicans from their political shortsightedness or if it’s rescuing Americans from what Republicans have put into motion. Will Democrats wait until after the midterm or presidential elections to let Republicans take a hit first? Maybe so.
But put yourself in the place of a family of four, who now accesses health insurance through an exchange and stands to lose it after the repeal, if nothing takes Obamacare’s place. The first people that family will blame will probably be the Republicans (“Thanks, Trump!”) for upending their access to health insurance. But the next round of finger pointing could easily end up at the Democrats if they filibuster any attempt to give that family access to insurance again, simply because it was the Republicans who took it away in the first place.
That kind of illogic is a big part of the reason Democratic Sen. Joe Manchin III said he wouldn’t attend the president’s meeting with Democrats Wednesday. "With all due respect to all of these people, we had the outgoing president coming up here to talk to only Democrats. We have the incoming vice president coming up to talk only to Republicans. That's not what makes this place work,” the West Virginia Democrat said. “That is what is wrong with this place."
That talent for rejecting partisanship has ingratiated Manchin to voters in his home state, but he has his own political realities, too. He’s up for reelection in 2018 in a state where Donald Trump just won by 42 percentage points. Read that again — Trump didn’t win with 42 percent. He beat Hillary Clinton in West Virginia by 42 points, with 69 percent of the vote. Manchin’s case may be extreme, but it isn’t unique. He’s one of 10 Democratic senators up for re-election in states that Trump won while loudly promising to repeal and replace Obamacare.
As a political matter, “Don’t Blame Us, We Warned You” probably won’t work as well in 2018 as “Yes We Can” did in 2008. And refusing from the beginning to vote for any replacement at all to Obamacare threatens to leave the fate of millions of Americans in the middle of a political fight, when what they’ll need is a political solution.
Democrats are right that Republicans are in the process of breaking Obamacare. That’s the whole point. But blame for failing to replace it may end up on everyone’s hands.
Roll Call columnist Patricia Murphy covers national politics for The Daily Beast. Previously, she was the Capitol Hill bureau chief for Politics Daily and founder and editor of Citizen Jane Politics. Follow her on Twitter @1PatriciaMurphy.