OPED: No easy option for GOP in health care debate

James Lewis
Tribune News Service

For more than six years, it was nearly impossible to find a Republican talking about health care who didn't make use of the overly simplistic phrase, "Repeal and replace."


And now, thanks to some healthy gerrymandering and President Donald Trump's coattails, those lawmakers have their chance to put those words into action.

As they say, though, you should be careful what you wish for.

Just weeks into Trump's presidency, congressional Republicans are struggling to make good on their years of pledging and, mostly, it's because they have no plan.

Beyond lacking a plan, Republicans are also facing strong headwinds on repealing the law. Recent polls showed that support for the Affordable Care Act, commonly called Obamacare or the ACA, jumped 6 percent following Trump's inauguration.

Leaked audio from last month's congressional Republican policy retreat revealed just how much Republicans are struggling with this challenge.

At the retreat, Rep. Tom McClintock, R-Calif., told his colleagues: "We'd better be sure that we're prepared to live with the market we've created. ... Republicans will own that lock, stock and barrel, and we'll be judged in the election less than two years away."

Here is the current situation:

Under the imperfect Affordable Care Act, 20 million American adults have gained health care coverage. For many, this health insurance is the only they've ever had.

These gains have nearly halved the uninsured rate, and the rate has dropped even more dramatically in states that expanded Medicaid coverage for moderate and middle-income families. Repeal of the ACA risks these important gains.

The leaked audio also included the thoughts of Rep. Tom McArthur, R-N.J., who said, "If we do this too fast, we are in fact going to pull the rug out from under them."

Stripping millions of families of health care is politically dangerous, and the states where the biggest reductions occurred are important to Republicans. Of the four states that have reduced their uninsured rates most, three strongly backed Trump and congressional Republicans. In fact, Arkansas, Kentucky and West Virginia only sent one Democrat to Congress across 13 congressional districts.

These are also states that, battling a raging opioid epidemic, have benefited from the ACA's addiction treatment coverage requirement.

Faced with this political reality, the rush is on for a new Republican plan.

Key Republicans are already starting to run away from their "repeal and replace" rhetoric and instead are beginning to use another "R" word, one used by Democrats for years: "repair."

Frustratingly, though, others have doubled down on their "repeal and replace" demand.

What replacements do they have in mind?

In 2014, Sen. Orrin Hatch, R-Utah, then a ranking member of the Senate Finance Committee he now chairs, offered a proposal. In 2015, a revised Patient Choice, Affordability, Responsibility, and Empowerment Act was introduced.

While other proposals are circulating, any path forward will likely run directly through this legislation.

In order to pay for the bill, Republicans would make employer-provided health insurance a taxable benefit.

If you, like the majority of Americans, get your insurance as a benefit from work, you would, as a result, have to pay taxes on it.

This could mean a pretty hefty tax hike for middle-class families. An estimation from Ezekiel Emanuel, a noted bioethicist, shows that a family of four making $150,000 per year could pay an addition $1,500 in taxes.

Through the leaked tapes, we know that some leaders are not happy with this plan. Sen. Bill Cassidy, R-La., said, "It sounds like we are going to be raising taxes on the middle class in order to pay for these new credits."

Consequently, Republicans now find themselves solidly between a rock (raising taxes) and a hard place (backtracking on six-plus years of anti-ACA rhetoric.)

If they would have worked across the aisle to repair the ACA, maybe they wouldn't be so trapped.

— James Lewis is a former senior policy analyst at Robert Weiner Associates and the former issue advocacy director of the Young Democrats of America. Readers may send him email at