Repeal Obamacare without a plan? Not so fast, say some in the GOP

 President-elect Donald J. Trump is learning one important thing about presidential governance, even before his inauguration this Friday: it is vastly different than campaigning. And, when it comes to keeping his campaign promise of repealing the Affordable Care Act, known as Obamacare, he is learning that there is no easy path, despite telling the Washington Post, late Saturday night, that he has a plan that is “all but finished” and that he wants “insurance for everybody.”

Anxious GOP Senators such as Susan Collins are urging a “go slow” approach to ensure that the party does not get blamed for any failings. She has said, “"We just want to make sure that we get it right.” Of course, the big debate after a nearly 60 year old attempt by several presidents, to come even this close to health coverage, (universal coverage aside), is in and of itself a big question. Critics say Republicans had six years to work with the Obama administration, and refused, so why now the rush?

It would be far better to have a detailed framework of what replacement is going to include as we are moving toward repealing;” Collins says, and that “one of the problems with Obamacare is that it was rushed through without input from Republicans for the most part, and we realize that insurance markets are complicated. And we don't want people to fall through the cracks.”

Along with four other senators, .when “asked whether the amendment signaled that Republicans were increasingly less concerned about overhauling Obamacare on the most expedient timeline, Republican Sen. Bill Cassidy of Louisiana, another author of the amendment, pushed back,” reported CNN.

"My gosh. If you're going to say we're going to fly to the moon but we're going to do it in March instead of next week, would you still feel it's pretty urgent?" Cassidy said. "You'd say, oh my gosh, we've got to get to work!"

Despite the cautious optimism, Trump intends to push it through, and in his usual bellicose way, just short of his normal platitudes of “amazing,” has told the Post, “It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon.”

“The Congress can’t get cold feet because the people will not let that happen,” Trump said during his interview with The Post.

What is missing from this non politician, now president, is how he plans on getting the votes and courting any Democrats to come along with the defeat of President Obama’s signature legacy. “I think we will get approval. I won’t tell you how, but we will get approval. You see what’s happened in the House in recent weeks,” Trump said

When the new Congress was sworn in last week, two things were done: the repeal with the Senate and House approval and, secondly, a budget resolution to remove the funding mandates, this gutting the legislation. Some Democratic lawmakers have said they have never seen the Republican controlled Congress move this fast, on anything.

Of the deepest concern are what happens to the 20 million people that have received coverage and what plan can replace it? Even more, vexing, are holding the more popular parts of the legislation, no lack of coverage for preexisting conditions,and an extension of coverage - till the age of 26 - for young people on their parents policies.

If Trump conceives a plan of his own without Congressional input, new challenges will be had, along with some sleepless nights, for House Speaker Paul Ryan and Senate Majority Leader, Mitch McConnell who are under pressure to knit a coalition of divergent views from other party members.

Ryan has said, “We don’t want to pull the rug out from anybody, we don’t want people to be caught with nothing.”

Meanwhile Vice-president elect Mike Pence, has said, that anything from Trump would “ensure that there is an orderly transition during the period after we repeal Obamacare to a market-based health care economy in America.”

Trump has said that drug prices would be negotiated with manufacturers to ensure fiscal affordability, yet with no details, one wonders how he could instantaneously achieve this without congressional input, on a matter that has been debated for over thirty years. Of course, it is not impossible, our neighbors to the north, in Canada, have done it for decades. But, in America it has been anathema and seen, by many, as the path to  pure socialism.

Nothing will be done, or announced, until the confirmation of the nominee for the Health and Human Services Secretary, Tom Price, although it is not clear why the wait, and what his role will be. “It's all about the confirmation," and. "Nobody's looking past that date,” said a Trump transition official to CNN.

Keeping to a timetable will be paramount as Trump plays to his base supporters who are expecting to see some action, not only on healthcare, but also the border wall with Mexico.

Remembering that Obama’s “law took more than 14 months of debate and hundreds of hearings. To urge lawmakers on, Trump plans to attend a congressional Republican retreat in Philadelphia this month,” according to CNN.

Leading medical groups, and even many conservative health policy experts and leading physician groups, including the American Medical Association, are also asking the GOP to not roll back the law without first developing an alternative.

While much misinformation on the ACA has been promulgated, primarily by GOP critics, the benefits that nearly 20 million people have received have too often been ignored, or distorted by its critics. One claim even had physicians making less than $4.00 per hour, due to premium increases.

Sen. Collins

“Some states have over a hundred percent increase.” in premiums, said Trump in his first news conference last week. That statement, however, was an exaggeration, and reflects a misunderstanding of a fundamental part of the ACA. In truth, state-by-state datum show a weighted average increases in range from 1.3 percent in Rhode Island to a high of 71 percent in Oklahoma. The most common plans on the health exchanges will see an average increase of 9 percent, before repeal,according to the Kaiser Family Foundation.

In an interview with The Detroit News, Michigan Gov. Rick Snyder, who was among the first Republican governors to expand Medicaid coverage through the law said his state was a national model of what could have been achieved.

If all else fails then the marching order from Trump are to blame the Democrats so that the law will “fall of its own weight.”

Democrats, in turn, have responded that Republicans “seek to rip healthcare away from millions of Americans -- creating chaos for our entire community, said a warning Charles Schumer, the senate majority leader (D-N.Y.).

On Tuesday, Huffington Report  showed that “The Congressional Budget Office just issued a report on the likely effects of a Republican effort to repeal Obamacare immediately but keep some elements of the coverage expansion in place for two years”

They note that “The numbers are staggering and suggest the GOP will find it difficult to keep its promise of an “orderly transition,” unless they deviate significantly from a prototype repeal bill they passed last year.”

The plan is for Republicans to stick closely to the repeal legislation that they crafted in 2015 and sent to President Obama, a year ago, which he, in turn vetoed. That bill deleted the unpopular insurance mandate that required Americans to have health insurance to pay a fine. It also “rolled back federal aid for Medicaid; scrapped federal insurance subsidies for low-and moderate-income consumers; and eliminated a Medicare surtax on high income households and other taxes on medical device makers and health insurance companies that dfo toward funding the law,” said The Chicago Tribune.

“Within the first year, the CBO predicts, 18 million people would lose insurance. In addition, premiums for people buying coverage on their own would increase, on average, by 20 to 25 percent relative to what they would be if the Affordable Care Act remained in place,” said Huff Po.

Speaker Ryan

Response from the GOP leadership was swift and condemning: “This projection is meaningless, as it takes into account no measures to replace the law nor actions that the incoming administration will take to revitalize the individual market that has been decimated by Obamacare,” AshLee Strong, spokesperson for House Speaker Paul Ryan (R-Wis.), said on Tuesday.”

Additionally, 32 million more Americans would be without health insurance, and even more so without the mandates and the federal subsidies, were delays to be held. Also, if repeal and delay is seen, “the COB estimates that premiums would eventually increase by 50 percent. But that’s only in the first year. By 2026, the CBO predicts, premiums would double, clarified Huff Po from their previous report.

The war of words and campaign rhetoric are making life uncomfortable for the GOP when Candidate Trump promised “something terrific,”:to replace Obama’s signature legislation. But, there will be even more words if “repeal and delay” is their move. One of them might be impeachment.