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With the election of Donald Trump as president, Republican lawmakers finally have a repeal of the Affordable Care Act, the healthcare law better known as Obamacare, in their sights.
But while Republicans control the presidency and both houses of Congress, a repeal of Obamacare may not come as soon as “day one” the way leaders like Paul Ryan and Mitch McConnell have said.
According to Bloomberg’s Sahil Kapur, there is no consensus among Republicans as to when a repeal should take place, but GOP staffers are floating the idea of waiting until after the 2020 presidential election.
Several plans put forth by Republicans would feature a “repeal and delay” mechanism, in which a law is passed that “repeals” the ACA but goes into effect only after a given period of time. This, the thinking goes, would give lawmakers enough time to craft a replacement and also avoid possible political fallout from potentially leaving some people without health insurance.
With over 20 million people having gotten health insurance through various provisions of the ACA, pulling the rug out from under these Americans could be politically dangerous for Republicans.
The original repeal-and-delay plan that was floated in November would have delayed the repeal date until 2019, after the first midterm election.
This move would carry significant risks. Politically, Trump could lose his reelection bid, thus costing the GOP its chance at repealing the law. From the market side, a long delay could cause insurers to pull out of the individual insurance market in anticipation of the move, destabilizing coverage for millions and causing prices in the market to soar.
Bloomberg also reported that Republicans were planning to present the Obamacare law as failing on its own, thus making repeal more palatable despite the coverage increases.
Counter to this narrative, however, the Department of Health and Human Services reported last week that 6.4 million people had signed up for plans on the exchanges established by Obamacare since open enrollment began on November 1 – the quickest sign-up pace of any of the four open-enrollment periods under Obamacare.
At the same time, premiums have increased significantly for 2017 and there are still too few young people on the exchanges.
Still, the biggest challenge for the GOP will be coming up with a replacement plan, and while numerous plans have been floated – from Ryan’s Better Way to the Empowering Patient’s First Act proposed by Tom Price, Trump’s pick to lead the Department of Health and Human Services – a consensus replacement has yet to be reached.