The Republican Repeal and Delay Plan for ObamaCare

The Republican Repeal and Delay Plan Explained

We explain the Republican ObamaCare “repeal and delay” plan which plans to defund and repeal ObamaCare and then delay a replacement.

UPDATE 2019: This plan never passed, and thus some specifics here are of historical interest only.

SEE: ObamaCare 2017 Repeal and Replace Updates for up-to-date information. This page explains “repeal and delay” the strategy, the link above covers the updates.

TIP: ObamaCare (the ACA) is still the law of the land. It is very unlikely that cost assistance would be repealed before 2018, as that would require rescinding promised cost assistance from those who are enrolling now. However, nothing is impossible. We will keep everyone updated. Learn more about what happens to cost assistance under Trump and the Republicans.

TIP: Repeal and delay is a nickname for the GOP repeal plan (like ObamaCare is a name for the Patient Protection and Affordable Care Act). The name comes from the fact that Republicans in Congress plan to pass measures to defund and repeal ObamaCare ASAP but plan to delay implementation of the defund and repeal measures while they work on a plan. In sum, the defund, repeal, and replacement efforts are all subject to “delay.” It is unclear if Trump embraces this for TrumpCare, but it is clear that he has promised a replacement plan that includes provisions that are currently on the GOP chopping block (so that should be noted).

ObamaCare “Repeal and Delay” Summarized

Republicans have not been forthcoming about the details of their plan. This is true for the defund, repeal, delay, and replace aspects. Thus, we are left to speculate based on what they have said and done so far. The repeal and delay plan works like this:

1. Republicans in Congress have begun their repeal and delay plan for ObamaCare through a process known as budget reconciliation. Their goal is to defund key provisions of the ACA by not providing funding for them in the budget. Defunding is a complex process that will likely take some time to implement. It is explained in detail in a VOX interview with an expert on Congressional procedure.
2. Then, after the budget measures are taken, they plan to pass a repeal bill (in which a repeal may be voted on now but delayed for years; i.e. the plan pass the repeal ASAP but delay the actual repealing of provisions giving them time to come up with and pass a replacement plan).
3. Meanwhile, they will likely pass temporary fixes while they work on a full replacement. We can assume they will pull these fixes from past GOP healthcare plans (so expect age-based tax credits rather than income based ones for example). Despite temporary fixes being likely, there are some provisions (like the mandates) which could be defunded or repealed sooner rather than later.

NOTE: It is possible that Trump gets his way and we get a simultaneous repeal and replace. With that said, we can’t report something so impactful based on a hopeful sentence. Until we see a replace plan on the table, we should assume we are facing the GOP repeal and delay plan.

Some Problems With Repeal and Delay

One problem with the logic behind the plan is that the GOP has already had decades to work on health care legislation. Since they have focused on the ACA for the past 8 years, it is strange that The Republicans do not have a workable plan ready; they have only proposed plans like the Ryan, Price, and Hatch plans. A second huge problem with repealing the ACA is that ObamaCare’s provisions work in tandem to ensure affordability for individuals, families, insurers, and the state. If you repeal the mandates, but not the subsidies, or the subsidies but not the mandate, or preexisting conditions protections, but not the subsidies, it could cause instability in the market and affect the costs of consumers, providers, or federal and state governments.

TIP: Forbes published an excellent article that explains some of the problems with the repeal and delay strategy. See their article for more “cons of repeal and delay.” Obamacare Repeal Results In Tax Cuts For The Rich; Tax Increases And Lost Insurance For The Rest.

A Few Other Key Points

• The GOP plans to repeal key provisions of ObamaCare by defunding it via budget reconciliation; this roundabout processed is planned because Democrats can’t block it as it only takes 51 votes to pass and Republicans control enough seats to pass it without any votes from Democrats.
• Even though the budget will be passed in early 2017, the defunding process will take time, and it is likely 2017 will continue as normal with the changes starting 2018 or later. The same is true for an expected upcoming repeal bill; it is likely that the vote on a repeal bill in 2017 will delay dismantling the law in full until 2020, although nothing is certain.
• Speaking of uncertainty, Republicans don’t have a replacement plan ready, despite having a few old plans around. There is no workable replacement plan on the table for people to debate.
• The Republican’s strategy to defund, repeal, and generally “break” ObamaCare without a replacement plan ready is called “repeal and delay.” Here “delay” refers to the way defunding, repeal, and replacement are all “delayed.”
• The idea might be to make Americans suffer so badly they all just want the remnants of ObamaCare to go away even without a replacement. Equally possible is to take credit for passing a repeal without having to deal with the effects of that repeal by delaying them for years. Their strategy includes waiting to implement anything with widespread negative repercussions until 2020 after Congressional elections have taken place.
• Although many will be happy not to lose the ACA right away due to delay, the gradual dismantling of the law starting with cost assistance and Medicaid expansion seems likely to destroy it piecemeal.
• America should be demanding a workable replacement plan that improves on the ACA. As Obama said recently, “show me.” 20 million lives are at stake today, and countless more will be in the future. We have our fingers crossed that past comments from Paul Ryan hint that temporary fixes will be put in place. For example, they may defund cost assistance, but then implement the age-based cost assistance from the “better way” plan. Those fixes may not be better, but at least they are “something.”

UPDATE: Republicans are also trying to repeal and replace Medicaid, Medicare, Planned Parenthood, Social Security, and more using an identical defunding strategy. Google it. If Obama, Clinton, LBJ, or FDR passed a law, it is on the chopping block. Republicans theoretically have replacement plans, but if ObamaCare is any indicator, the replacement plans might be more vague ideas than actual plans. President Obama might be able to use his Veto powers thanks to checks and balances, until January 20th when the administration changes. See Obamacare, Planned Parenthood Prevail Again.

What is at Stake?

Details aside, here is what that means for ObamaCare’s fundamental Patient Protections and Affordable Care Provisions:

• Aspects of the Affordable Care Act that can be changed through reconciliation include cost assistance, Medicaid expansion, and the individual and employer mandates. This means repealing the requirement to offer full-time employee’s coverage or pay tax.
• Elements that would likely remain in place include the guaranteed issue of plans, the prohibition on preexisting condition exclusions, modified community rating, essential health benefit requirements, and actuarial value standards.

Can Democrats Stop the Republicans from Defunding ObamaCare?

The problem is that Democrats can’t stop Republicans defunding ObamaCare. Republicans only need 51 votes to pass the budget (a simple majority), not the same 60 votes that Democrats needed to pass the ACA. The Democrats can’t filibuster it. Thus the only way to block defunding is if enough Republicans stand against it which isn’t likely.

So far Rand Paul has stood up. He wasn’t pleased with the $9 trillion in spending over the next 10 years as a trade off for rushing a repeal, but Rand Paul can’t save ObamaCare alone. One should note that he doesn’t want to. He doesn’t want to cut and spend like the rest of the GOP, but he still wants to cut.

Defunding is part one of the repeal and delay plan, but it isn’t the whole plan.

The Next Step After Defunding: Delay, Repeal, and Maybe Replace

After breaking the program and “starving the beast.” This term, “the beast” is what Republicans call the government and all the government programs except those that benefit them directly. The next plan will probably be to begin pushing for a repeal bill.

The repeal bill will require more votes. I think Republicans hope that, if they defund the program and people suffer enough, then everyone will want a repeal. We know they have this card up their sleeve; it is what they did with Medicaid expansion and the exchanges after National Federation of Independent Business v. Sebelius).

The Delay

Defunding and repealing isn’t ideal, but it might well be fine if there were a replacement plan on the table. The problem is there isn’t. Instead, Republicans have suggested that they may wait 2 – 4 years to replace ObamaCare!

The Replacement?

They may or may not bring out one of the old Republican replacement plans like the Hatch “Patient CARE Act” plan or Ryan “Better Way” plan. Trump may push for this (after all, he promised TrumpCare). However, Trump’s current language doesn’t suggest he has a concrete plan on the table.

Maybe the GOP is just trying to see if people will put up with delaying a replacement plan. That tactic almost worked when they tried to repeal an ethics committee in the middle of the night. Maybe if enough people object, they might take their promise of a replacement plan seriously.

A similar tactic may be used to gain support for any future Republican replacement plan. People’s health care could become so compromised that “something being better than nothing.” When constituents begin to lose the coverage or cost assistance they have under the ACA, there will be a lot of pressure on Democrat legislators to support a replacement, even if it isn’t comprehensive.

These Tactics Were Expected, But That Doesn’t Excuse Them

Most people expected that the GOP would try a repeal via reconciliation since that is what “defund ObamaCare” tactic has been about for a while now. However, a repeal and replace plan received serious consideration throughout the campaigning season.

With the GOP rushing giddily to defund cost assistance and Medicaid expansion, 20 – 22 million newly insured Americans are now about to face hardship.

Since there is no serious talk of a replacement plan in sight, we all have reason to be concerned about this repeal and delay strategy.

We need to let the GOP know that “a replacement plan is reasonable, but you need to do what you promised and make healthcare great again…don’t just defund, repeal, and delay.”

Or as the Democrats say, Let’s not “Make America Sick Again.”

TIP: VOX has done an excellent job of providing intelligent articles on the ACA in this difficult period. Check out a few of their best articles here.