If you confine yourself to the Congressional Record, you would assume that Republicans methodically followed their game plan to dismantle Obamacare in the first week of the new session. The Senate passed the first phase of their repeal bill under a process called reconciliation, a budget procedure that requires only a simple majority in the Senate, without opportunity for filibuster. The Senate should wrap up in the coming weeks with a “vote-a-rama” (where Senators vote on all amendments consecutively for hours on end) and a final vote, and the finished product will move to the House, for likely passage days after Donald Trump’s inauguration.
But Republicans spent more time firming up the process of repeal than on the substance of the bill, which thus far includes no detail on what will be repealed or when, or what will eventually replace the current system. It’s like they practiced how to walk down the aisle over and over without knowing whether they will say “I do.”
This absence of detail has created a vacuum, filled with fear and infighting and jockeying for position. Hard-liners and moderates are consumed with the timeline for delay. But Tom Cotton became the first senator to publicly oppose repeal without a replacement, echoing the sentiments of others in private. Meanwhile, polling for “repeal and delay” is horrendous. And any replacement will have to contend with furious lobbying from insurers and major medical groups.
Furthermore, familiar politics are already tripping up the process. Republicans really want to eliminate Obamacare’s taxes on high-income households, insurance companies, and medical-device manufacturers; repeal should actually be seen as a tax-cut bill in the short-term. But Rand Paul’s concerns about the deficit led him to oppose the bill, and while he has failed to rally conservatives to his side thus far, money for a replacement will likely have to come from somewhere to appease the budget hawks. Separately, in a funhouse-mirror echo of the Stupak amendment, House Republicans want to include defunding of Planned Parenthood in the repeal, like the dry-run repeal bill did last year. But Susan Collins and Lisa Murkowski have threatened to fight such a measure, making Senate passage less likely. And that’s just the beginning of the knock-down, drag-out fights to come over every line of a replacement bill.