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Republicans kick off their ACA repeal crusade

If Republicans were counting on an effortless repeal ACA process to go through once they were in power, they set themselves up for disappointment.
Image: Pelosi and Schumer talk about the Affordable Care Act in Washington
Senate Democratic Leader Chuck Schumer and House Democratic Leader Nancy Pelosi speak following a meeting with U.S.President Barack Obama on congressional...

A Republican senator on condition of anonymity said the details of the repeal bill remain very uncertain. Originally, Republicans were planning to simply bring back the bill they put on Obama's desk last year for his veto.But that bill was written knowing it wouldn't become law, and now some Republicans want to make tweaks to soften the blow of repeal."Even people who voted for this before are, 'Wait a minute, wait a minute, we knew that wasn't going to happen,'" said the senator. "There were no consequences." He said there's a growing sense among some of his colleagues that they need to have a replacement for Obamacare ready soon "because we're going to own this."

It's a fascinating perspective. Congressional Republicans held literally dozens of ACA repeal votes in recent years, knowing that they were just spinning their wheels in a self-indulgent vanity exercise. GOP lawmakers hardly had to think about what they were doing -- choosing instead to throw together ridiculous legislation that give their radicalized base a temporary sugar high.But Americans have now asked a party that doesn't take public policy seriously, and has little use for substantive work, to be a governing party -- and suddenly, Republicans haven't the foggiest idea what to do. They know they hate "Obamacare," but they're less sure why, and even less sure still what to do about it. They're moving forward with a sudden realization that "consequences" count.The "dog that caught the car" is easily the most overused cliche in this debate. It also happens to be true.So what happens now?Keep an eye on Republican divisions. There's broad agreement among GOP officials in support of some kind of "repeal and delay" model, which we've discussed in some detail before, in which Republicans would repeal the ACA in the short term and set some kind of multi-year deadline to craft, debate, and approve a conservative alternative. As the Washington Post's Greg Sargent explained yesterday, GOP leaders keep throwing around rhetoric about a "bridge" that would connect consumers from the current system to the next, but none of this has been backed up with anything substantive.It's a process fraught with risks. Republicans do not yet agree among themselves how quickly to proceed, what any of the details should look like, how to reach any of their stated goals, or how to avoid a political catastrophe in which they'd be blamed for causing systemic chaos and putting millions of families in peril.As for the Republicans' alternative to the ACA, they've been promising to unveil such a package since June 2009. That was 90 months ago.Keep an eye on the data. Republicans are heavily invested in the idea that the ACA is already failing. They're wrong. In fact, enrollment figures have reached an all-time high; research shows the recent jump in premiums were part of a "one-time pricing correction"; and fewer Americans are skipping medical care because of cost -- "most likely because, thanks to the health care law, so many more people have health insurance."To the extent that evidence matters in the political debate, ACA proponents have facts on their side.Keep an eye on the doctors. When the American Medical Association endorsed the Affordable Care Act during the legislative phase seven years ago, it gave the proposal an enormous boost. It was nearly as important yesterday when the AMA urged congressional Republicans not to pursue any policy that would undo the gains achieved in recent years.The group also insisted that Congress not repeal the ACA unless it has a sound alternative in place, which is the exact opposite of the course most Republicans intend to pursue.Keep an eye on the hospitals. Other than American families, no institution has benefited more from the ACA than American hospitals. It therefore mattered a great deal when the nation's hospital industry warned Republicans a month ago that their current plans risk triggering "an unprecedented public health crisis."Keep an eye on the insurers. Insurance companies keep trying to warn Congress not to be irresponsible, or lawmakers risk insurers abandoning exchange marketplaces altogether. For all of the industry's complaints in recent years, private insurers have made clear they want a system that looks an awful lot like the status quo.Sen. John McCain (R-Ariz.) said yesterday insurance companies "have no relevance to me," adding, "I don't want to hear from 'em," That's a pretty dangerous approach given the circumstances.Keep an eye on the congressional vote counts. GOP lawmakers can pass a "repeal and delay" scheme through the reconciliation process, which means Democratic won't be able to filibuster it. But in a 52-48 Senate, health-care opponents can afford very few defections. There's no specific bill on the table yet, but fissures are already emerging, and there's no reason to assume Senate Republicans will vote in lock step.Keep an eye on the benchmarks. Prominent Republicans, including Paul Ryan and Kellyanne Conway, have vowed to move forward with a GOP health care plan in which no one who has insurance loses their coverage, consumers with pre-existing conditions keep their protections, no one "is left out in the cold," and no one "is worse off." If Republicans try to keep these promises, it's very likely they'll fail.Keep an eye on governors. Just this week, two Republican governors from states that voted for Trump -- Ohio's John Kasich and Michigan's Rick Snyder -- voiced support for elements of the ACA and said Medicaid expansion under the reform law should remain intact. They're not alone. The more Republicans at the state level express concerns about Congress' repeal crusade, the more lawmakers will feel pressure about scaling back their far-right ambitions.Keep an eye on Democrats. Politico had an interesting report this morning about Dems using health care as a rallying cry: "Brandishing a new slogan, 'Make America Sick Again' adapted from President-elect Donald Trump's campaign, they're holding rallies in Ohio, Pennsylvania and West Virginia, featuring the stories of thousands of the red-state Americans who have benefited from the law. Those rallies will culminate in several nationwide events beginning Jan. 15 where they will warn of the chaos likely to ensue if the health law is repealed without a replacement plan."Keep an eye on Trump. The president-elect doesn't know anything about health care policy, and has never been able to string two complete sentences together explaining what it is about "Obamacare" he doesn't like. Trump does know, however, that he wants to avoid blame if he and his party screw this up spectacularly, which is probably why he tweeted to Republicans yesterday, "Be careful!"The Huffington Post's Jonathan Cohn had a great piece on the broader dynamic two weeks ago, positing that Paul Ryan's crusade to pass repeal in January "has nothing to do with policy and everything to do with politics.... [H]e wants Congress to vote before the rest of the country, and maybe even the president-elect, wakes up to the real-life changes such a vote would unleash."The original fight to pass health care reform, after a century of effort, was a laborious process. Over the course of 14 months, there were dozens of hearings, hundreds of debates, countless rallies, and a divisive national argument. The result was an imperfect law that's done an enormous amount of good for millions of people -- which has literally saved many Americans' lives.If Republicans were counting on a swift, effortless repeal process to go through once the levers of power were under their control, they set themselves up for disappointment.