Here’s a modest prediction: While congressional Republicans may look disorganized and a bit hapless right now, they are going to get their act together at some point and craft an official proposal to replace Obamacare. Then Donald Trump will try to sell the plan by lying about what's in it.
That's the most obvious solution to the political impasse that the GOP is fast approaching. And it means that news organizations, which collectively found themselves incapable of helping voters discern truth from fiction during the presidential campaign, need to figure out ahead of time how they will cover a policy battle in which the president of the United States has no attachment to—or perhaps even understanding of—the basic facts involved.
This week, Republicans on Capitol Hill are confronting two unpleasant realties: Snuffing out Obamacare may not be as simple as they hoped, and any replacement proposal acceptable to conservatives may be unacceptable to the public. The party's original legislative game plan—“repeal and delay”—was to pass a filibuster-proof budget reconciliation bill that would eliminate the Affordable Care Act's major planks after two or three years, then use that sunset period to concoct a substitute. That strategy now looks shaky, as a number of Republican senators have said they would prefer to repeal and replace Obamacare simultaneously, or at least see an official replacement plan on paper before voting to repeal. That, of course, would make the process take longer.
Trump, meanwhile, has weighed in with the firm but unrealistic demand that Republicans both repeal and replace Obamacare with extreme haste. “We have to get to business. Obamacare has been a catastrophic event,” he said on Tuesday. As for the time table for replacement, he said, “Long to me would be weeks” and that "It won’t be repeal and then two years later go in with another plan.”
Inconveniently, that would require the GOP to reach a consensus on how to reform America's entire health insurance system over the next month or so, something it hasn't been able to accomplish in the six years that it’s controlled the House of Representatives. It would also force Republicans to grapple with the fact that every single replacement proposal their party has put forward would leave fewer Americans with health coverage than under Obamacare. And while kicking families off of their insurance in order to pass large tax cuts for the wealthy may be acceptable to conservative ideologues, it isn't exactly an election winner.
Unsurprisingly, Republicans have been shy lately when asked about their plans for health reform. Take this athletic dodge from Nevada Sen. Dean Heller, reported in Bloomberg:
Senator Dean Heller, a Nevada Republican up for re-election in 2018, declined to say whether he believes the GOP plan will cover as many people as Obamacare.
"I would anticipate nobody’s going to lose their health care for the next two or three years until the replacement is put in place. I think that’s pretty fair," he said.
And after two or three years?
"That’s a lot of prospective thinking," Heller said. "You can ask me in two or three years."
The early Republican disarray has lead some to speculate that the party may settle for mostly cosmetic changes to the Affordable Care Act—rebrand it Trumpcare and call it a day (which would be appropriate enough, given that the president made a whole second career stamping his name on buildings other people built). Jonathan Chait is already suggesting that, if the current trends continue, “Obamacare, or something substantially similar, is probably going to survive.”
This seems premature. Lest we forget, Senate Democrats spent months fighting over the details of Obamacare—first trying in vain to wrangle some sort of bipartisan compromise, then fine-tuning a bill that both Sens. Bernie Sanders and Joe Lieberman could agree on. At times, the whole effort appeared poised to unravel over seemingly tangential issues like abortion funding. It was a long, exhausting legislative tightrope walk, performed above a pit of screaming conservatives tuned into Rush Limbaugh.
Given how hard it was to erect the Affordable Care Act, nobody should have thought that tearing it down and rebuilding something in its place would be a swift or painless process. Republicans may have set some unrealistic expectations by promising to slay Obamacare within a hot minute of Trump taking the oath of office. But even with the speed bumps they've hit, the health care industry has still been “stunned,” as the New York Times puts it, by just how quickly they've managed to move to repeal the law. Meanwhile, Trump has picked Georgia Rep. Tom Price to be his secretary of health and human services. Price has written his own replacement plan and signed on with the proposal House Speaker Paul Ryan put forth this summer. The White House is going to offer up something, and Senate Republicans are going to feel ample pressure to back it.
Is it possible that the replacement effort will collapse under the weight of its own contradictions? Maybe. As many (Chait included) have argued, Republicans dislike Obamacare in large part because it taxes the wealthy in order to expand insurance coverage to the poor and working class. But because that's not a politically palatable position, they've attacked it for insuring too few people while saddling them with expensive premiums and high deductibles. Those are real problems for which Republicans don't have any actual solutions; instead, the GOP has drafted proposals that would let the government spend less on health care and maybe allow young, healthy adults (mostly men) to purchase cheap coverage that currently doesn't exist because of Obamacare's regulations. Selling those ideas to a public that's been told they're already paying too much for bad insurance will be hard. Selling Democrats on it will be even harder. And since Republicans only have a 52-seat majority in Senate, they need some opposition votes to overcome a filibuster.
But Republicans may also be led by just the con man for the job. Donald Trump does not know anything about health care. But he does care about winning, about cutting taxes, and about undoing his predecessor's legacy. And he has no compunctions about spouting nonsense, or lying outright, about pressing policy issues. If the Congressional Budget Office says a Republican replacement plan won't cover 19 million people, do you think Trump will give a damn? Do you think Trump even knows what the Congressional Budget Office is? He'll happily go on Hannity and tell the country that everybody will get great, cheap coverage, better than anything they've had before.
So here's how I see the fight shaping up: Republicans will come up with an Obamacare replacement and Trump will tout it with a barrage of hyperbole utterly divorced from reality, just like he touts everything. At that point, the debate becomes a struggle to win over public opinion, plus whether Republicans can find eight Democrats to go along for the ride. If journalists treat Trump's sales pitch credulously—or even lead with a bunch of headlines along the lines “Trump Says X”—it's going to give the GOP an advantage and help the party squeeze Dems like Joe Manchin of West Virginia. If instead reporters spend time asking Trump basic questions like whether he can actually explain the details of his own health care plan, Obamacare may have a fighting chance. Even then, they'll have to cut through reams of noxious internet propaganda and Trump-friendly reporting from Fox News and Breitbart.
Which one will it be? I don't know. How much faith do you have in the efficacy of the fourth estate these days?