The Republican health care scheme starts to take shape

U.S. President-elect Donald Trump (L) meets with Speaker of the House Paul Ryan (R-WI) (C) and Vice-President elect Mike Pence on Capitol Hill in Washington, D.C., on Nov. 10, 2016. (Photo by Joshua Roberts/Reuters)
U.S. President-elect Donald Trump (L) meets with Speaker of the House Paul Ryan (R-WI) (C) and Vice-President elect Mike Pence on Capitol Hill in Washington, D.C., on Nov. 10, 2016.
Next month, Republicans will take control of the entirety of the federal government for the first time in a decade. What will the radicalized party tackle first? By some accounts, health care.

Vice President-elect Mike Pence said Tuesday that repealing and replacing ObamaCare would be the first item on President-elect Donald Trump's agenda after Trump takes office early next year."It'll be the first thing out of the gate," Pence told Fox News' Sean Hannity on "Hannity." "The President-elect's made it very clear. He wants the Congress when they convene in early January to take up the task of repealing and replacing ObamaCare first."

Pence added at an Ohio rally last night that the Affordable Care Act will be replaced "with American solutions," which was a curious thing to say. For one thing, the ACA blueprint came from Mitt Romney, not a foreign government. For another, Pence knows as well as anyone that the reform law has produced amazing results for Americans -- most notably in Indiana, where the law has slashed the state's uninsured rate by more than a third.Nevertheless, the far-right vice president-elect's comments, which are consistent with what congressional GOP leaders have been saying, suggest the fight over Americans' access to health security is going to get quite intense almost immediately after Inauguration Day.Unwrapping the Republicans' plans, however, is a little tricky, and some of the coverage has been a little confusing, so let's take a couple of minutes to set the stage for what's to come.What do Republicans want?They want to repeal the Affordable Care Act for reasons they often struggle to explain accurately. That said, many in the party, including Donald Trump, have said they're reluctant to scrap some of the law's more popular provisions.Such as?As it turns out, protections for consumers with pre-existing conditions -- which poll extremely well with the American mainstream, regardless of party, and which Trump has publicly committed to keeping -- are proving to be the most important part of the entire debate.How come?Because it's something of a keystone. As Republicans have discovered, keeping these protections necessarily leads to a series of related provisions ... which start to look an awful lot like "Obamacare."OK, but after all of this time to figure it out, Republicans must have a plan of their own, right?Wrong. GOP policymakers began working on their ACA alternative in the summer of 2009, and despite frequent assurances that their plan was almost ready, GOP officials have come up with nothing that can serve as the party's official solution.Republicans had the luxury, however, of knowing they didn't actually have to do any real work. The ACA already passed; it's working; and even if far-right lawmakers figured out how to write an alternative, President Obama wouldn't sign it into law. GOP officials enjoyed their total lack of responsibility: they could complain endlessly, while casting dozens of meaningless votes to repeal the reform law, knowing that none of it had any practical significance.And now?Now the dog chasing the car caught up to the bumper.After the elections, there were several reports that said repealing the Affordable Care Act would be far more difficult than Republicans appreciated. Were they right?Good lord, yes. The ACA isn't some appendage attached to the nation's health care system that can be removed with a legislative cleaver; it's interspersed by design throughout the system. Getting rid of it, without hurting families, the economy, hospitals, states, insurers, and countless businesses, would take effort, patience, expertise, and legislative skills.So?At least for now, Republicans have no use for effort, patience, expertise, and legislative skills. They want to attack and figure out the details later. Sometime. Eventually. Maybe.Well, at least Republicans are on the same page when it comes to health care policy.Actually, they're not. At this point, Republicans don't agree among themselves about how best to proceed, and while they're deliberating, hospitals and insurers are warning GOP officials that clumsily attacking the federal health care system would do enormous damage -- with no substantive upsides.OK, but they may not care about substantive upsides. What about the political upsides?The latest polling shows the public appetite for the Republicans' ACA repeal agenda is far weaker than the party likes to believe -- even among Trump voters.If the GOP has no plan, how can they pursue a "repeal and replace" strategy?They really can't, which is why Republicans have quietly transitioned from "repeal and replace" to "repeal and delay."Oh, great, another misguided catch phrase to learn. What in the world is "repeal and delay"?Soon after the election, when Republicans realized their health care goals were within their grasp, they came up with a strategy in which they'd repeal the ACA first, but it wouldn't take effect right away. The scheme would then set a deadline for Congress to pass something new, probably in two or three years.Wouldn't the insurance market collapse in the interim?Almost certainly, yes, but congressional Republicans have apparently begun talks with insurers in the hopes of preventing such a crisis.What kind of policy could these talks produce?No one has any idea.Does this have something to do with the "Obamacare Cliff" I've been hearing about?Yes. The idea is, through "repeal and delay," there would be a firm deadline, at which point the health care system would effectively collapse. The point would be to create an incentive for policymakers to work something out, knowing that inaction would lead to disaster.Wouldn't it be smarter for Republicans to work on a policy first, rather than play with some dangerous artificial mechanism that sets an arbitrary deadline?Of course it would, but GOP officials worry that pursuing this rationally and responsibly would effectively ensure that the Affordable Care Act remains intact indefinitely, which they consider a politically unpalatable outcome.What would be the Democratic role in all of this?That's one of the more important details. As Republicans see it, the beauty of "repeal and delay" is that it gives the GOP some leverage. As the deadline approaches, Republicans would effectively tell Dems, "Go along with our lousy reform plan, even if you hate it, even if it hurts a lot of people, because the alternative would be the complete collapse of the entire system -- which you don't want."That sounds like a dangerously cynical approach to hostage politics.It sure does.To be sure, there are several gaps remaining. We don't know, for example, what the GOP majority will try to pass through the budget-reconciliation process, which would render a Democratic filibuster in the Senate irrelevant. For that matter, we don't know if Republicans will do away with filibusters altogether.