Republicans have no real plan to establish a new health care system if the courts strike down the Affordable Care Act before the 2020 election. But plenty of them are rooting for its demise anyway — even if it means plunging the GOP into a debate that splits the party and leaves them politically vulnerable.
After a decade of trying to gut Obamacare, Republicans may finally get their wish thanks to a Trump administration-backed lawsuit. Its success would cause chaos not only in the insurance markets but on Capitol Hill. And Republican senators largely welcome it — even if they don’t know what comes next.
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“I’m ready for it to succeed,” said Sen. Mike Rounds (R-S.D.). “I would love to get back in and actually deal with health care again.”
“Do I hope the lawsuit succeeds? I do,” said Sen. Kevin Cramer (R-N.D.). “What I wish is we had some idea where we are going if it does succeed, as it looks more and more like it might.”
Even Republicans not known for taking a hard line are eager for a forcing mechanism to take on Obamacare.
“I have a plan that I would be delighted to have Congress pick up and go forward with,” added Sen. Mitt Romney (R-Utah) of a proposal to protect pieces of the law. “Necessity is the mother of acceptance. I hope that we reach that necessity and that would propel my proposal to see a good deal of support.”
Both Cramer and Romney said GOP discussions were picking up about how to step in if the law falls after a U.S. appeals court indicated last week it could kill all or part of the law, though the Supreme Court would have the final say. Democrats and Republicans are also working on a modest package of bills intended to lower health care costs.
But when it comes to major changes to Obamacare, the parties aren’t talking.
Democratic leaders have no intention of working with the GOP since they want the Affordable Care Act to survive. And there’s no reason to think that Senate Republicans could unify on a replacement to the law after previously failing to do so.
“If it did succeed, I would be very concerned,” said Sen. Susan Collins (R-Maine) of the lawsuit. “I don’t think there’s a plan in place to take care of individuals who’ve been using the exchanges to purchase their insurance or who have been covered under the Medicaid expansion. I’m just hoping the court doesn’t strike it down.”
Democrats are ready to hammer Republicans if the law gets taken down because of the GOP lawsuit. Democrats took back the House last year in large part because of their focus on health care.
Senate Minority Leader Chuck Schumer (D-N.Y.) called the GOP’s stance “repeal without a replace.”
“Every plan Republicans have put forward has failed to maintain the protections offered under the current law,” he said. “It’s pretty simple: If you care about maintaining protections for people with preexisting conditions, you don’t demand they be taken away.”
Sen. Joe Manchin (D-W.Va.), a close Schumer ally, added, “They better do something. If not, this is all on them. This is all on Mitch McConnell.”
Republicans may be wagering that Democrats would jump into negotiations to protect popular provisions in Obamacare and somehow forge a new compromise health care law — all in the heat of the presidential campaign. Senate Majority Leader Mitch McConnell (R-Ky.) has said Congress would act immediately on pre-existing conditions if the courts strike down that part of the law.
But it’s also possible that the law would simply collapse and Congress play a blame game for months as millions of Americans struggle to deal with the fallout. Republican efforts to create a new law fell short in 2017, and Democrats are not exactly unified on whether to protect Obamacare or embrace a larger role for government like with “Medicare for All.”
It’s difficult, if not impossible, to see how the parties would compromise a year from now. McConnell quickly shied away from President Donald Trump’s talk of restarting efforts to replace the law earlier this year, and in May said, “It’s not possible” to reconcile the GOP’s priorities with Speaker Nancy Pelosi’s on a major replacement bill.
In interviews, several Senate Republicans insisted that Congress could get its act together. But veterans of the health care wars are not so sure.
Sen. Lisa Murkowski (R-Alaska), who killed the GOP’s repeal push with Collins and the late Sen. John McCain, observed dryly of the efforts to replace Obamacare: “You know how much I loved that fight.”
Sen. Shelley Moore Capito (R-W.Va.), who voted with her party in 2017 on the so-called “skinny repeal”, signaled she was also eager to avoid another wide-ranging health care debate.
“I can’t say that I hope it succeeds,” she said of the lawsuit. “I think the strategy from here on that I’ve adopted in my own mind is repair. Repair what we’ve got.” She then pivoted into a GOP line that will be heard for months: “You know, you see the Democrat presidential candidates. They want to scrap it, their own creation.”
The Democratic focus on moving beyond Obamacare — either through Medicare for All or through proposals to let people buy into Medicare — could further complicate any effort by Congress to react to a potential Supreme Court ruling that strikes down Obamacare, a decision that may occur next year if the appeals court shoots down the law in the coming months.
The lawsuit backed by GOP attorneys general, the Trump administration and many GOP lawmakers argues that the Affordable Care Act should collapse now that Congress has zeroed out its individual mandate in a Republican tax law. A previous Supreme Court ruling had used the mandate as reason to uphold the law.
Collins said she viewed the case as clear-cut: Congress’ failure to repeal the entire law in either a standalone bill or the tax law is evidence that lawmakers were focused only on the mandate in the tax bill.
But plenty of her colleagues hope she’s wrong.
For Sen. Ron Johnson (R-Wis.), the collapse of Obamacare in the courts “would be a relief.”
“I would anticipate that the court would give a certain level of time for Congress to get its act together in a way that actually works,” Johnson said. “We’re not going to turn the switch on right away, but doesn’t hurt to have a deadline.”
Yet Republicans also admit the lawsuit has the potential to be politically damaging, not just to Trump but to their Senate majority.
Republicans are fighting a pitched battle to defend their 53-47 majority, and polls show Democrats have the high ground on health care amid GOP efforts to dismantle the Affordable Care Act.
“I only fear the political consequences of” false Democratic attacks, said Sen. Mike Braun (R-Ind.), who backs efforts to protect pre-existing conditions.
He said he worried Democrats might not join efforts to prop up those protections “for some technicality just so they can keep coming at us for the lawsuit.” But Republicans conceded that if they don’t begin preparing for the potential maelstrom their party has created, it will be their own fault.
“That people are concerned about losing the Affordable Care Act is testament to the fact that the United States Congress hasn’t done its job,” said Sen. John Kennedy (R-La.), who is “ready” for the lawsuit to succeed. Obamacare has “not made their lives better, but yet people worry that as bad as it is, if we don’t have it, we have nothing.”