With an estimated 22.8 million newly insured people since the launch of the ACA, why are Republican law makers so eager to repeal it without a backup plan? Trump's comments were basically "We're going to cover everyone, it's going to be great!" he has yet to comment or give details on their plan.

Republicans had 6-8 years for a plan. Why haven't they come up with a replacement yet? I just hope this doesn't turn a back and forth between Democrats and Republicans where one repeals and the other re-instates.

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    Paul Ryan has already released a plan. And there is only about 12 million ACA enrollees – K Dog Jan 19 '17 at 3:12
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    @Kdog, can you give me sources for Ryans plan and where are you getting 12 million? Most of the reports are saying it's in the 20m range. @ sabbahillel, well that's politics. Obamacare was based off of Romney's health plan. I live in one of the states where the declined medicaid expansion. I hope they at least have a pre-existing coverage as I was unable to get insurance do to my pre-existing condition. – Noah4343 Jan 19 '17 at 3:38
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    Those numbers are based on Surveys, not enrollees. dailysignal.com/2017/01/13 – K Dog Jan 19 '17 at 3:46
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    Ryans plan has been out since June google.com/… – K Dog Jan 19 '17 at 3:50
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    @KDog, thanks for the link with no articles lol. I looked around and the 12 million doesn't take into account Medicaid expansion, Health Insurance and Marketplace coverage – Noah4343 Jan 19 '17 at 3:58

Republicans had 6-8 years for a plan. Why haven't they come up with a replacement yet?

They did. There are at least three (Rand Paul says "about fifty"). Note that Tom Price (nominee for Health and Human Services, the department that oversees the PPACA system) is known for writing one.

  1. Tom Price
  2. Phil Roe
  3. Paul Ryan

All three of these are actual bill proposals from the most recent Congressional term. Apparently there is also some chatter about reviving the old Bob Dole plan of offering everyone the same choices available to federal government employees. Obviously that wouldn't be a current bill although there might have been one in 1996.

It's worth noting that most new coverage under the Patient Protection & Affordable Care Act (PPACA; popularly called Obamacare) is based on Medicaid, not the exchanges (example source). While the exchanges have twelve million enrollees, some of those were covered before and switched either voluntarily or as a result of plan loss.

Beyond that, most of the Medicaid effect was what is called "woodwork effects" meaning that people previously eligible signed up because they, well, asked. In other words, most of those who signed up for Medicaid were eligible for Medicaid prior to PPACA but didn't enroll until after it was passed. These people would still retain coverage after PPACA repeal even without a replacement.

Similarly, many Obamacare exchanges are state programs. While a Republican Obamacare replacement may remove the subsidies to those plans, it wouldn't be able to remove state-run exchanges even if it wanted to do so. Remember that there were seven Supreme Court votes against unfettered federal oversight in the Medicaid expansion portion of PPACA. One of those votes was Antonin Scalia, but even if his replacement ruled differently, that's still a six vote majority against federal interference. So they may lose subsidies, but people who want to buy plans on exchanges would still be able to do so.

why are Republican law makers so eager to repeal it without a backup plan?

Repeal can be done in reconciliation, which only requires a simple majority in the Senate. Republicans have a simple majority in the Senate, so they can repeal it.

Passing a replacement that does more than fiddle with budget numbers requires a sixty vote supermajority in the Senate under current law. Republicans, unlike 2009 Democrats, do not have a sixty vote supermajority (fifty-two Republicans; forty-six Democrats; two Independents who caucus with the Democrats). So they would need support from at least eight Democrats or Independents to pass a replacement.

It would be difficult to find eight Democrats who will vote to repeal Obamacare, even with a replacement. Several of the more likely candidates for voting for a replacement voted for the original bill and would face problems with their base if they voted for replacement. However, post-replacement there are ten Democrat Senators in states that Trump won. Those ten will have difficulty voting against a reasonable replacement.

Finally, Republican politicians have been promising to repeal PPACA since 2010. Now that they can, a better question is why would they wait? Waiting hits them with their base, and it's not like they are suddenly going to get votes for doing nothing from those who prefer waiting. The simple political calculus is that there are more rabidly anti-PPACA Republicans than there are pro-PPACA Republicans. They need to appeal to pro-PPACA people in a way that does not lose them their anti-PPACA supporters. Immediate repeal satisfies the anti-PPACA, and a replacement could satisfy the pro-PPACA.

This is the fundamental problem with purely partisan legislation. It has no support from the opposing party, so now that the opposing party has taken control, they have zero incentive to retain it. And every incentive to repeal it.

Even worse is how the Barack Obama administration ran the program. They picked high profile fights with groups asking for religious exceptions, thereby ensuring that there was a committed opposition. This despite promises not to use the bill to promote abortion that were made during passage. They fundamentally lacked empathy for the point of view of the religious objectors.

Of course, they would tell you that the problem is that the religious objectors were taking a ridiculous stance. That's an understandable viewpoint, and it's possible to empathize with their frustration in dealing with what seemed absurd to them. However, regardless of how the administration felt, the result was that the pro-life crowd is absolutely and completely opposed to PPACA. While the pro-life movement is only a small portion of the Republican electorate, it is a much larger portion of the funding and volunteer base.

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  • Wow, excellent answer! One last thing though, Trump said he would keep parts of the law so how would this play out when he wants a 'fix' rather than 'repeal' He campaigned on repeal but than changed his stance. – Noah4343 Jan 19 '17 at 13:00
  • It's unclear if he thinks of his stance as having changed. He believes that pre-existing condition coverage and coverage until 25 of dependents are good goals. Presumably he wants them to be in any replacement. Note that provisions narrowly tailored to those purposes could be passed. He has also indicated that he wants a replacement passed shortly after repeal. It's indeterminate how practical that is. He may find himself more supportive of the establishment approach after actual negotiations with Democratic Senators. – Brythan Jan 19 '17 at 13:10
  • I forgot about Price's plan!!! – K Dog Jan 19 '17 at 14:26
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    Good answer, except that the conscientous objections went way beyond abortion, and opposed other types of birth control as well. Abortion was already banned from Medicaid prior to PPACA, and remained so with PPACA. – jalynn2 Jan 19 '17 at 20:58
  • As I said, you may find the assertion that IUDs and morning after pills are abortion to be ridiculous and/or absurd, but those asking for religious exceptions on the basis that life starts at conception don't. And, while Medicaid is most of the increased coverage, it's not involved in the employer mandated coverage. – Brythan Jan 20 '17 at 1:35

While Brythan's points are as usual excellently made, he did not get into some of the rationale for the immediacy of repeal, and why Obamacare has been so disastrous for the Democrat party politically and why Republicans are so eager to repeal. First about timelines, really what's needed is an operable solution sometime by next summer with enrollment to begin in the fall.

First, the economics have been nothing short of disastrous for working Americans:

Obamacare has cost roughly 300,000 small business jobs due to higher health care costs, according to a new report. The American Action Forum, a center-right policy institute, released findings Wednesday that rising premiums and regulations under the Affordable Care Act have had “dire” consequences for the labor market.

The report found the law has cost $19 billion in lost wages per year and forced 10,000 small businesses establishments to close their doors. The study covered employers with 20 to 99 employees.

CBO estimates echoed very similar findings years ago, and they have only gotten worse.

Second, Obamacare distorts the insurance market, making the individual plan market unvialbe. This was the year that many insurance firms finally expected to break even in the exchanges, even with Obama, some say illegally, diverting billions of dollars to insurance providers. Instead, they are leaving the Obamacare exchanges and remaining prices are skyrocketing, causing a death spiral.

Aetna CEO Mark Bertolini said that this was supposed to be a break-even year for its ObamaCare business. Instead, the company has already lost $200 million, which it expect that to hit $320 million before the year it out. He said the company was abandoning plans to expand into five other states and is reviewing whether to stay in the 15 states where Aetna (AET) current sells ObamaCare plans. Aetna's announcement follows UnitedHealth Group's (UNH) decision to leave most ObamaCare markets, Humana's (HUM) decision to drop out of some, Blue Cross Blue Shield's announcement that it was quitting the individual market in Minnesota, and the failure of most of the 23 government-created insurance co-ops. And it follows news that insurance companies are putting in for double-digit rate hikes that in some cases top 60%, and news that the Congressional Budget Office has sharply downgraded its long-term enrollment forecast for the exchanges.

Finally, as stated before, Obamacare, as how Obama's administration is running the program, is against federal law and has implications for both Medicare and Medicaid programs, and points to its sustainability, not in the long term, but this year.

Experts have pointed out that with the absence of payments to the U.S. Treasury in 2014 and 2015, the Centers for Medicare and Medicaid Services owes the U.S. Treasury $3.5 billion in payments from the transitional reinsurance program—$2 billion for 2014, and $1.5 billion for 2015.

“CMS to date has diverted $3.5 billion from the Treasury to help the insurance companies, effectively bailing out insurance companies with taxpayer dollars,” Pitts said.


In short, the Obamacare program is hurting working Americans grievously, is distorting the insurance market and the individual market is no longer viable, is no longer sustainable in the short term, and is operating illegally. In such a situation, it's incumbent upon the new administration to address.

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    How does the amount of repeal that can be accomplished with reconciliation fix those problems? According to the CBO, it could very well accelerate the death spiral if there is no replacement. – jalynn2 Jan 19 '17 at 21:02
  • @jalynn2 The very short-term consequence of repealing Obamacare is people simply not having health insurance - which is hardly a death spiral. Exit the system, let it recover, get back in (once health insurance works how it used to work). If there is a death spiral (perhaps some bit of Obamacare that couldn't be removed in reconciliation wreaks havoc), then that provides an impetus for Congress to properly repeal it afterward. – Brilliand Mar 27 '17 at 18:53

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