The other potential problem is Senator Lamar Alexander, who as chairman of the Senate Health, Education, Labor, and Pensions Committee, will have a lot to say about the repeal effort. Alexander voted for repeal last year, but in recent days he has made clear that he prefers a different strategy for ending the ACA: “replace and then repeal.”
Explaining his position, Alexander cited Trump’s interview on 60 Minutes, where he promised there would be no gap between the exit of Obamacare and the arrival of its replacement. In a statement on Thursday, he said he wanted repeal to occur in stages:
Immediately in January, Congress and the administration can begin to repeal Obamacare and provide relief from the Obamacare emergency. And as President-elect Trump has said, Congress should replace and repeal at the same time, which requires figuring out how to replace it before fully repealing it. To avoid the historic mistakes of Obamacare, that replacement should be implemented step-by-step to minimize disruptions and make sure the changes in the system work well. Conservatives especially know that a comprehensive health care solution—even a Republican one—for a country of 320 million people in 50 states won’t work.
The Problems With Delay
In theory, the delayed death strategy seems reasonable, even responsible. Republicans don’t want to throw 20 million people off their health insurance if they can avoid it, and even the most ardent critics of the Affordable Care Act understand that a transition period is needed. “That gives us time to put the replacement in place and not just strip the rug out from under people,” said Representative Steve King of Iowa, who has been fighting Obamacare since its inception. “We need to give people confidence that we’re planning for that.”
In practice, however, delay could be a disaster. Insurers have already been leaving the Obamacare exchanges, leading to fewer options and higher-priced plans for shoppers. Repealing the law could cause a further exodus long before the measure takes effect. As Robert Laszewski, the president of Health Policy and Strategy Associates, told Vox’s Sarah Kliff: “The problem is when you have an insurance market, and the new administration declares it DOA, it will go into death throes.” Laszewski and other industry experts have said that Congress could mitigate the fallout by temporarily increasing subsidies for insurance companies, but that is exactly the kind of policy that Republicans derided as a “bailout” and successfully killed a couple of years ago.
The Challenge of a Replacement
There’s a reason the Republican Party hasn’t been able to agree on a single, comprehensive legislative alternative to Obamacare in the last six years: Conservatives are divided on the details, health policy is incredibly complex, and the plans they have come up with will be difficult to sell to the public—especially once Democrats start highlighting the many people who will lose Medicaid coverage or face higher costs as a result. Recall that Democrats only barely passed the Affordable Care Act in 2010 when they had 59 seats in the Senate, or seven more than the GOP will control next year.