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The Republicans' overdue realization: Health care reform is hard

Publicly, the GOP seems to have no idea what it's doing on health reform. Privately, the GOP seems to have no idea what it's doing on health reform.
Rep. Paul Ryan (R-WI) at the Iowa GOP Lincoln Dinner at the DoubleTree by Hilton in Cedar Rapids, Iowa April 11, 2014.
Rep. Paul Ryan (R-WI) at the Iowa GOP Lincoln Dinner at the DoubleTree by Hilton in Cedar Rapids, Iowa April 11, 2014.
Republican officials have been working on their alternative to the Affordable Care Act since June 2009 -- literally 90 months ago -- with periodic assurances that the GOP reform plan is nearly done and poised for its unveiling. Any day now. Just putting the finishing touches on it. It's gonna be awesome. Just you wait.And wait.Of course, those laughable assurances pre-date Donald Trump's presidency, and on Jan. 10, the Republican declared, "We have to get to business." With that commitment in mind, Trump said his party would repeal Obamacare "probably sometime next week," and he'd be ready to move forward on a replacement "very quickly or simultaneously, very shortly thereafter." Even at the time, these vows didn't make any sense, and two weeks later, they appear slightly worse.This week's Republican retreat was intended to help get the party on track in pursuit of their long-sought goal, but those ambitions fell short, too. Trump made an appearance, and told his GOP allies how impressed he was with his election and inaugural crowd sizes, but he offered no guidance on health care and refused to take questions from the Republican audience. GOP lawmakers themselves wanted to reach some consensus on a reform direction among themselves, but didn't.And that's not the worst of it. Publicly, Republicans appear to have no idea what they're doing on health reform, and privately, Republicans really don't have any idea what they're doing on health reform.

Republican lawmakers aired sharp concerns about their party's quick push to repeal the Affordable Care Act inside a closed-door meeting Thursday, according to a recording of the session obtained by The Washington Post.The recording reveals a GOP that appears to be filled with doubts about how to make good on a long-standing promise to get rid of Obamacare without explicit guidance from President Trump or his administration.

The Washington Post's report added that GOP lawmakers -- from both chambers -- confronted a lengthy list of concerns for which they have no clear solutions: "how to prepare a replacement plan that can be ready to launch at the time of repeal; how to avoid deep damage to the health insurance market; how to keep premiums affordable for middle-class families; even how to avoid the political consequences of defunding Planned Parenthood, the women's health-care organization, as many Republicans hope to do with the repeal of the ACA."In other words, they're still struggling with the most basic of details. Despite all the chatter about the party intending to act within months, their years-long effort to draft a Republican plan hasn't amounted to much more than bold ambitions and over-the-top rhetoric.Rep. Tom McClintock (R-Calif.) was recorded saying he and his GOP colleagues "better be sure that we're prepared to live with" the market they create after moving forward with repeal. "That's going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we'll be judged in the election less than two years away."The Washington Post's Greg Sargent raised an important point about this McClintock quote: some Republicans like to maintain the fiction that they can avoid responsibility if they gut the Affordable Care Act and the GOP's approach makes matters much worse, but the California congressman's comments are a reminder that this isn't at all realistic.The recordings also feature Rep. Tom MacArthur (R-N.J.) explaining to his colleagues, "We're telling those people that we're not going to pull the rug out from under them, and if we do this too fast, we are in fact going to pull the rug out from under them."We're nowhere near a point at which ACA proponents can start to breathe easy, but it wasn't long ago that Republicans were talking about having health care legislation on Trump's desk in January. Instead, Democrats and supporters of health security have received quite a bit of good news; health care activists have started getting more engaged; and the law itself has become more popular than the politicians who are desperate to kill it.It's against this backdrop that Republicans find themselves in a ditch they dug for themselves. That's not to say their crusade will end anytime soon -- it won't -- but for now, they're lost without a map.Disclosure: Because I mentioned Planned Parenthood, I'm noting that my wife works for the organization, but she played no role in this piece.