Republicans have had seven years to work on alternative solutions. More importantly, they have previously voted on repeal bills, including one that Barack Obama vetoed. It might take longer to replace Obamacare with something else, but a simple repeal should have been quickly achievable. They simply had to redo what they had done previously.
A replacement might take longer, but they could have done replacement on their own pace. Of course, many Republicans don't want to replace Obamacare, which is the problem that the American Health Care Act had--too many Republicans thought that it retained too much Obamacare.
The primary reason why repeal has been a priority is that it blocked tax reform. The nature of Obamacare means that Democrats won't vote to change the Obamacare taxes. So tax reform has to work around those taxes. If they had repealed the new taxes first, then they would have had more room to adjust taxes.
Note that repeal was not their first order of business. The first order of business was a series of resolutions using the Congressional Review Act to repeal regulations made late in the Obama administration.
Even Obamacare itself took many years to negotiate.
Actually, the Patient Protection & Affordable Care Act took only a little over a year to negotiate. It was entirely new legislation in 2009 and passed in 2010. There was no bill in 2008 from which they could work.
If you want to credit previous years of negotiation (e.g. the 1993-1994 health care failure), then you have to credit those to the Republican plan as well.
The wide consensus is that Obamacare is not perfect so there's definitely ways to modify it without it being incredibly unpopular.
The problem here is that the publicly unpopular parts of Obamacare aren't what causes its problems. There are three main policies that are unpopular:
- The individual mandate.
- The "Cadillac" tax on expensive plans.
- The employer mandate.
The "Cadillac" tax hasn't taken effect yet. So it's not causing problems. It's just unpopular.
The general expert view is that the individual mandate is too weak, not too strong. Too many healthy people choose to pay the mandate penalty rather than buy insurance. But even the current mandate is unpopular.
The employer mandate struggles because it is of the type "if this then that." Rather than buying insurance or paying the penalty, employers are avoiding employing people at the margins. For example, someone who is only part-time doesn't trigger the mandate. And small employers don't trigger the mandate. So many employers have been limiting the number of full-time employees to be just under the mandate. And medium-sized employers have been avoiding the mandate for some of their employees by keeping them part-time.
The problem is that none of these have easy fixes. They are unpopular, but critical to how the law works. The "Cadillac" tax is probably the easiest, as it's just revenue. The mandates don't have significant alternative solutions. Even though these are unpopular, most Democrats won't join in repealing them.
Another policy with wide support for changing is the medical devices tax. It's not terribly unpopular, but it isn't particularly popular either. Medical device makers hate it. And again, it's just revenue.
The real problem is with fixing the law to work better. There's no easy solution for that. The primary problems with the law relate to how it was fundamentally designed to operate. For example, the individual mandate is too low. But the mandate is already unpopular. There's no political movement to increase it.
Too few young, healthy people enroll. There isn't enough money to pay for older or sicker people. Possible solutions include allowing insurance companies to charge higher premiums in general or to charge older people higher premiums than younger people. We could increase the already expensive subsidies. But people don't want to pay more themselves and aren't eager to pay more taxes to bail out insurers.
There is a requirement that 80% of premiums pay for medical/health care; any excess beyond that must be rebated. That takes away any incentive for insurers to control costs. Administrative costs like checking for fraud come out of their 20% and reduce the 80%. They're better off accepting the fraud and increasing premiums. Because the fraud has the effect of increasing their overall margin from which profits come. But this is a popular part of the law, however much it ruins the system.
There is no bipartisan consensus on solutions to the fundamental problems. Democrats would increase taxes and spending. Republicans want to cut taxes. As stands, neither has much interest in compromise. And it's unclear what the compromise between increasing and lowering taxes is. Do nothing? Not really the stuff of which legislation is made.
