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Obamacare: Repeal, Replace, Revive?

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Most Republicans would probably agree — putting a health care plan on paper was the easy part. Getting the party on board with it is another story. But repealing 974 pages of Obamacare shouldn’t be too difficult. Both the House and Senate proved that in 2015 when they sent the Restoring Americans’ Health Care Freedom Act to an uncooperative President Obama. Not surprisingly, he didn’t waste any time vetoing the measure that gutted Obamacare and redirected about 80 percent of Planned Parenthood’s federal funding to community health clinics. Although the 2015 repeal set the stage for the GOP’s 2016 election success, the road to repeal has been a bumpy ride, especially now that the public is finally getting a chance to look at the text of their plan.

Already, House conservatives are showing just how fragile the peacekeeping process may be, as at least two Republican caucuses and a handful of senators pushed back on the pillars of Speaker Paul Ryan’s (R-Wisc.) American Health Care Act (AHCA). As the Wall Street Journal explains, “Their objections focused on a new program of tax credits, replacing the existing health law’s subsidies, which GOP leaders say would help a wider set of people buy insurance if they don’t get it at work.”

In some members’ opinion, the tax credits are too similar to the subsidies in the law they’re trying to replace. Senator Rand Paul (R-Ky.) has been outspoken in his objections, calling the plan everything from Obamacare Lite to Obamacare 2.0. Others, like Rep. Jim Jordan (R-Ohio), are taking a more proactive posture and suggesting alternatives of their own. The objections are causing plenty of heartburn on the Hill, where Ryan and Majority Leader Mitch McConnell (R-Ky.) need every ounce of GOP support to get a bill across the finish line. Unless Democrats suddenly decide to listen to voters and work to scrap the law, leaders can’t afford to lose more than two senators and 22 congressmen on the plan.

But not everyone thinks the tension in Republican circles is a bad thing. “If they have 218 votes, we won’t get any change. That will be the bill,” Senator Paul told reporters. “If they don’t have 218 votes, there will be a negotiation and conservatives will have a seat in the table.” Like a lot of conservatives, FRC agrees with portions of the AHCA. It eliminates two of the problems with the healthcare Hydra: the individual mandate and taxpayers’ forced partnership with the abortion industry. What’s troubling is that the GOP seems to be surrendering to the view that health care is a government entitlement. Somewhere along the way, they succumbed to the idea that the government has to provide health care. As Holman Jenkins writes for the Journal, “Even under a GOP plan, health care will remain a heavily subsidized industry in relation to everything else Americans might rationally prefer to spend their money on.”

Fortunately, the White House seems to understand the severity of the divide and says it’s open to suggestions for improvement. House Freedom Caucus Chair Mark Meadows (R-N.C.) left a meeting with the Office of Management and Budget Director Mick Mulvaney last night encouraged that the administration hears their concerns. “We obviously enjoyed the exchange with Director Mulvaney,” Meadows told CQ. “This is not something that is in stone, and [the White House indicated] that they are open to finding a way that best protects people and truly makes health care affordable.” It’s time, Meadows agreed, “to negotiate and really look at things we can coalesce around.”

Let’s hope they do so quickly. Time is ticking on the repeal clock. Secretary Tom Price, who, as a congressman, had plenty of experience maneuvering measures through, isn’t too concerned. “You start at a starting point, people engage and they get involved in the process. We’ll work through it.” One thing they do all agree on (with the exception of liberal Republicans Susan Collins, Maine, and Lisa Murkowski, Alaska) is pulling the plug on Planned Parenthood. In a press conference today, Speaker Ryan even used that fact as leverage to get more conservatives on board. “[The AHCA] ends the funding to Planned Parenthood and sends that money to community health centers of which there are more of.”

With one-fifth of the economy riding on U.S. health care, Republicans can’t afford to get it wrong. Like Senator Mike Lee (R-Utah) and others, we believe the best approach is for Congress to repeal Obamacare as they did in 2015 and then address the replace holistically with a separate, well-crafted bill not limited by the parameters of reconciliation.

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