The Politics of TrumpCare

The Politics of TrumpCare

Admit it or not, the GOP will soon own the health insurance market.

President Obama and Vice President-elect Mike Pence both paid a visit to Capitol Hill Wednesday, in the first formal engagement over the future of the Affordable Care Act. Republicans finally have the power to repeal, but the question is whether they have the grit to replace ObamaCare.

Mr. Pence told Republicans that repeal and replace is the TrumpAdministration’s “first order of business,” while Mr. Obama ordered Democrats not to “rescue” the GOP by helping to pass a “TrumpCare replacement.” Going by his business background Donald Trump won’t mind putting his name on a health-care plan, or anything else, but Republicans need to appreciate the reality that they will soon own ObamaCare. Until they pass a coherent and market-oriented substitute, as a political matter ObamaCare is TrumpCare, like it or not.

This isn’t a great political position, given the law’s large and ongoing failures on almost every measure: premium trends, enrollment, limited doctor and hospital networks, insurer participation. Affordability, choice and competition are due for another tumble next year under the status quo.

Mr. Trump seems to appreciate the political danger, tweeting Wednesday that “Republicans must be careful in that the Dems own the failed ObamaCare disaster, with its poor coverage and massive premium increases,” adding “Don’t let the [Democratic Senator Chuck] Schumer clowns out of this web.”

But Mr. Trump isn’t some candidate bystander any more. What was the point of Mr. Pence’s visit to Congress if not to encourage Republicans to proceed with their plans for a quick repeal? Does the President-elect have any better ideas on legislative strategy, or is he merely going to toss around the sayings of Chairman Donald from Trump Tower?

Some Republicans think they can repeal ObamaCare and blame Mr. Obama for the fallout, but they are kidding themselves. Republicans were elected on a promise to repeal and replace, and the statute of limitations on blaming Mr. Obama will soon expire. Voters tend to punish politicians who can but don’t solve problems, even if they didn’t cause them.

Republicans began the repeal drive on Tuesday, introducing a budget resolution with instructions for “reconciliation.” This procedure bypasses the Senate filibuster for budget-related measures, and a simple majority can be used to dismantle ObamaCare’s insurance subsidies, tax increases, Medicaid expansion and individual mandate. But reconciliation can’t roll back one of the most damaging core features—the vast expansion of federal regulatory control and coercion over health care.

Thus much of the law could be legally repealed by mid-February or so, but with a deferred roll-up date of perhaps two or three years. And there’s little GOP consensus about an alternative. Mr. Trump campaigned on repeal but also left TrumpCare open to negotiation and, well, interpretation (“something terrific”). House Republicans united around sensible reforms, but legislating is harder than writing a campaign document.

The policy risk of this strategy is that repeal and delay could accelerate the collapse of the ObamaCare exchanges. Insurance markets depend on stability and predictability, and insurers are already planning policies for 2018. The new system can phase in, but the uncertainty of a long interval between the repeal and replace stages, or the possibility that the replacement never arrives, could disrupt insurance for millions.

The political risk is that the GOP defaults to procrastination, or reverts to its pattern of division and grandstanding. Conservative purists may try to block any credible replacement as ObamaCare Lite, much as Kentucky Sen. Rand Paul said Wednesday he will oppose the GOP repeal strategy because it might add to the deficit. Only in Washington could a self-styled libertarian oppose the repeal of an entitlement and claim fiscal virtue.

As for Democrats, they already seem to be following Mr. Obama’s no-compromise advice. Senate Minority Leader Schumer said at a press conference Wednesday that Republicans want “to rip health care away from millions of Americans, creating chaos in our entire economy.” Mr. Schumer called the GOP “the dog who caught the bus,” and he’ll be right if Republicans can’t deliver on a replacement within months, not years.

Republicans have a once-in-a-generation opportunity to govern and show that center-right reforms can improve on the top-down mandates of the entitlement state. If they muff this one, they’ll deserve to be run out of town.

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