Shortly after the November election, Republican leaders came up with a plan for Obamacare: They would repeal the law quickly upon President Trump taking office, and then delay its enactment so they’d have time to develop a replacement.
The strategy became known as “repeal-and-delay,” and it was catching on with Republican lawmakers, particularly on the right, until it ran into a blockade led by two powerful men: Senator Rand Paul of Kentucky and soon after, Donald Trump.
“I just spoke to @realDonaldTrump and he fully supports my plan to replace Obamacare the same day we repeal it,” Paul tweeted on January 6. “The time to act is now.” The soon-to-be-president picked up the ball and ran, vowing in tweets and interviews that there would be no gap between repeal and replace; Republicans in Congress, he said, would do the deed in the same week, or the same day. Heck, Trump even suggested repeal-and-replace “could be the same hour.”
Repeal-and-delay was dead. The concern, then as now, was that Republicans would never get around to a replacement, that it would need Democratic votes to pass, and that in the meantime, the insurance markets would collapse and millions would lose coverage or face sharply higher prices. On Trump’s orders, GOP leaders on Capitol Hill began working on a plan to roll back and replace the Affordable Care Act simultaneously, in one piece of legislation. And that remained the strategy through Friday morning, when repeal-and-delay shot back to life thanks to the two men—with help from a third—who killed it in the first place.
“If Republican Senators are unable to pass what they are working on now,” Trump tweeted, “they should immediately REPEAL, and then REPLACE at a later date!”
Paul rushed to back up the president and generate momentum for reviving the new, old plan.
I have spoken to @realDonaldTrump & Senate leadership about this and agree. Let's keep our word to repeal then work on replacing right away.— Senator Rand Paul (@RandPaul) June 30, 2017
It’s not clear whether Paul planted this seed with the president, or whether Trump got the idea from another GOP senator, Ben Sasse of Nebraska, who just minutes before Trump’s tweet was pitching the plan on Fox News’ morning program “Fox and Friends.” Under Sasse’s proposal, if the Senate does not reach an agreement on its current bill by July 10—the day Congress returns from a weeklong recess—it should move to a straight repeal bill. That legislation would come with a one-year delay in an effort to ensure that people don’t lose insurance while Republicans and Democrats work on a replacement.
Where the idea originated isn’t really important, however, and nor are the particulars of the plan. The repeal-and-delay ship has sailed. Republican senators from both ends of the party have bought into the chief criticism of the strategy—that it would destabilize the markets and risk a backlash from voters who suffer as a result. And if more moderate Republicans like Susan Collins of Maine, Lisa Murkowski of Alaska, Dean Heller of Nevada, and Shelley Moore Capito of West Virginia won’t vote for a replacement bill that would leave 22 million more people uninsured in a decade, they certainly won’t back straight-repeal legislation that, according to the Congressional Budget Office, would result in 32 million people losing their insurance. It was no surprise that a trio of Senate GOP aides promptly told Axios that the Trump/Paul/Sasse gambit was dead on arrival.
The real significance of Trump’s tweet is what it says about the GOP’s health-care effort now. The party is on the brink of failure. The president knows it, and he is frustrated. Republican holdouts forced Senate Majority Leader Mitch McConnell to abandon his plan for a quick vote on a partial repeal-and-replace bill this week, and then senators left town without bridging the chasm that divides conservatives and moderates.
Both sides appear to be running out of patience. Moderates like Collins and Murkowski have suggested the party engage Democrats, while conservatives are joining Trump in calling for a return to “clean repeal.” During a conference call that was scheduled before Trump floated repeal-and-delay, a group of conservative activists laid into both McConnell and the Republican moderates who they accused of “lying” about their position on Obamacare. They denounced the current draft of the Senate bill and mocked its unpopularity with voters.
“It’s a liberal piece of legislation that has been met with record low levels of support,” said David Bozell, president of ForAmerica. “The premium increases in this bill are higher than its approval ratings.”
The activists had convened the call with reporters to rally support for an amendment offered by Senator Ted Cruz of Texas that would allow insurers to sell pared-down insurance plans as long as they also offered policies that met the standards set by Obamacare, such as covering essential health benefits and people with preexisting conditions. It was, they suggested, the final compromise they would be willing to accept in a bill they described as “fake repeal.” But they found themselves increasingly supportive of Trump’s idea even as they acknowledged its chance of success was close to zero. “If Republican moderates want to oppose full repeal, they need to answer to the voters for their vote and not with the leadership protecting them,” said Andy Roth, vice president of government affairs for the Club for Growth.
The call was more venting session than strategy session. The Senate bill is not dead. McConnell is still trying to work out a compromise and sending language to the CBO for cost and impact analysis. The party is likely to make another push in July, and if a similar fail-first trajectory in the House is any lesson, the passage of time and increasing desperation can wear down critics and lead to an agreement.
But the odds are turning against Republicans now, and Trump is facing the prospect, once again, of an embarrassing failure that would force upon him an unpalatable alternative: working with Democrats he has mercilessly mocked over health care for months. His tweet on Friday was not the announcement of a grand new strategy; it was as close as Trump has come to admitting defeat.