Obamacare: The Republican strategy of partial repeal vs full repeal


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This National Review editorial today describes very succinctly the strategy being used by the Republican leadership in its effort to repeal Obamacare.

Senate Republicans want to pass a bill that repeals the taxes and spending in Obamacare, but not its regulations. That’s because they think that they can use a legislative process to avoid Democratic filibusters only if they leave the regulations alone. They think that this partial repeal of Obamacare will set the stage for later legislation that repeals the rest of the law and creates a replacement.

The heart of the problem for a full Obamacare repeal is that in the Senate you can pass budgetary items with only 51 votes while regulatory changes require 60. The Democrats plan to filibuster any regulatory changes, thus preventing their repeal.

The editorial opposes this strategy and instead calls for removing the federal government completely from health insurance regulation, the situation that existed prior to the passage of Obamacare. While I totally agree with this stance, I also recognize that the intransigence of the Democrats in the Senate makes it difficult. The only way it could work is if the Republicans could convince 8 Democratic senators to break away from their party and support full repeal. While a large number of Democratic senators are faced with difficult elections in 2018, I don’t think the Republicans could get 8 to agree.

We are thus faced with the unfortunate and bad situation that the Republicans will repeal only part of the law, which will further damage the health care industry. While they hope this damage will strengthen their effort to get the law entirely repealed, I fear that it will instead be used by the Democrats to attack the Republicans and the idea of the repeal itself.

It seems to me that it would be better to offer a full repeal, forcing a Democratic filibuster, and then use that filibuster as a campaign weapon to defeat more Democrats in 2018.

25 comments

  • wayne

    Mitch can waive the filibuster rule whenever he wants– but he does not want to do so.
    (Chuck is the only one who will be picking the next SCOTUS nominee.)

    The ACA isn’t going anywhere. RINO’s love it…now to pay off their friends. (and none of us, are their friends, of that I am positive.)
    Welcome to Obamacare version 2.0.

    A repeat from me

    Mark Levin interviews Daniel Horowitz on the non-repeal, repeal of the ACA.
    1-3-17
    https://youtu.be/iPxZ-o_m62A
    (10:15)

  • Wayne: Waiving the filibuster rule is not necessarily a good idea. It would allow the Democrats to appoint Supreme Court justices with only a majority, when they regain the majority in the Senate. Better to deal with the filibuster and use the Democrat’s use of it as a weapon in the 2018 campaigns.

  • wayne

    Mr. Z– you are correct, however that is in the future. I’m more concerned with the here-and-now.
    Mitch can waive it at any time, and reinstate it at any time.
    He’s a disingenuous liar in my opinion, always has been, always will be.

    “Donald Trump and Mitch McConnell cannot let Chuck Schumer play god.”
    Mark Levin 1-4-17
    https://youtu.be/sQZXBouZNEo
    (12:53)

    “I’m waiting for a tweet Mar-a-lago or Trump Tower. I’m waiting for a tweet that will emphatically state that Chuck Schumer’s position will not stand, that the incoming President of the United States will insist that the majority leader whose wife is now part of his Cabinet at the Department of Transportation, that the Republican Majority Leader, Mitch McConnell, will in fact suspend the filibuster rule to ensure that we can save this republic and ensure that the Supreme Court is populated with proper men and women who have respect for the Constitution. Because that’s what it’s going to take!” M. Levin

  • Diane Wilson

    It used to be that a filibuster required a Senator to stand and speak until passing out from unendurable bladder pain. Those were the days.

    I’d wager that the best way to negate the filibuster threat is to require actual filibusters. If a vote for closure fails, but no one wants to get up and speak, then the closure vote will be “deemed to have passed.”

  • Diane: That is a superb idea! Yes, that is exactly what the Republicans should do.

  • wayne

    Have to disagree.
    I don’t want theatrics and losing nobly.
    If the ACA doesn’t go away 100% this month, we’ll have it forever.

  • LocalFluff

    So the Senate requires 60% majority for decisions that the president veto and for decisions where filibustering is allowed, including appointment to the Supreme Court. That isn’t crazy. It does assume that existing law is better than existing politicians, but an objective advantage is more stable legislation and more consensus required for changes. That they have to stand there and make fools out of themselves is a price they have to pay for this influence, limiting its use a bit. Don’t they need to do that anymore?

    Trump wants to make many changes. He’ll surely require the majority leader or speaker to do what they can to get rid of the filibustering when possible.

    I gather that in 2018 ten democrat senators are up in states which Trump won. If the Democrats don’t reform their party until then, the Republicans could have a chance to win 8 of them and get the 60% majority. Obamacare will never become the Republicans fault more than it is the Democrats, could it? It carries Obamas name. This is something that the Democrats should get rid of and go on and negotiate something completely different in return. The legacy of Obama will not be a good thing for them to fight for.

    (How strong isn’t Trump/the Republicans with both Houses, 33 governors, 5/6 state legislative majorities, majority in the Supreme Court, and the Senate election in 2018 is such that a majority is virtually guaranteed his whole first administration. And add to that the neocons defeated and the Democrats split and in disarray, and news media’s credibility and economic viability dwindling. And Putin seeing a chance to get into the warmth from those Asian barbarian outcasts the West has reduced him to hang out with. The axis US-Russia will lead to several quick and important historic foreign policy successes for Trump to define already his first few months. Then the surrounded and isolated bubble Chinese will have to make alot of concessions.)

  • LocalFluff: We must remember that in 2008 the Democrats controlled both Houses of Congress and the Presidency. Moreover, they had a filibuster-proof majority in the Senate. What did that get them? It got them thrown out of office, for writing and passing bad legislation, of which Obamacare is the prime example.

    Should the Republicans do badly, they will face the same wrath of the voter. No majority is guaranteed, unless one side decides to take power by force and throw the Constitution completely away. And even that is always possible.

  • m d mill

    I agree completely with Wayne’s first comment.
    The 60 vote rule is completely artificial.
    Democrats HAVE and will at any time waive it for legislation “vital” to them.
    Republicans should do the same. Repeal it completely…let Senate democracy rule, as spelled out in the constitution.
    McConnell and most republicans are unwilling to repeal the ACA stipulations about preexisting conditions
    because its “mean spirited”. They want the “free lunch”. They really don’t want the free market solution,
    and will never defend it!!
    To repeal the funding rules without first repealing all the regulations and mandates is the easy and inane chicken way out, and will simply destroy the system even faster. The Republicans will be blamed for their stupidity, and they will deserve it. Truly affordable efficient sane hospitalization insurance ,which existed pre-ACA, will never be seen again. There is no well reasoned Republican replacement…its all posturing, and McConnell is the first among lessers.

  • Cotour

    I also agree with Wayne, the Republicans must push as hard and as forcefully as they can and get what they can and worry about the fallout later. But the solutions that are put in place must be reasonable and functional.

    I do how ever think that in the reality of the political situation they will tend to pull their punches while pushing hard to fulfill their agenda, if that makes any sense. Politics is politics. This initial six months to one year is no time to play nice, nice. The Leftist agenda must be soundly rejected and gutted from our country and a new direction must be initiated and executed. The one thing that MUST be erased is the individual mandate.

    Obama and his un American, Islamic sympathizing, 180 degree reverse American logic and his “fundamental change” agenda must be, like Obama himself, become just a foot note in the presidential lineage. Just number 44, thats all.

  • wayne

    m d mill–

    Good stuff. Right with you!

    Filibuster is not in the Constitution, it’s a rule of the Senate.
    We dodged a bullet with HRC, but the war is not over by a long shot.

    Whatever DJT actually is, ( and I have no clue,) Mitch, Ryan, Prius, and DeStefano, now run the show 98% and I know exactly who they are, and exactly what they intend to do, and none of us are invited to the party.

    If they don’t kill the ACA in it’s entirety, before the end of this month, we’ll have it forever.
    Mitch, Ryan, Prius, and the usual gang-of-suspects, they LOVE this Statism. They pretend to oppose it, fund-raise off of it all, hold meaningless show-votes, fail nobly, and nothing ever changes.
    They intend to rearrange the deck-chairs, run it “better,” and kick the can down the road.

    http://www.usdebtclock.org/

  • wayne

    “Fight of the Century”
    Round 2.0
    https://youtu.be/GTQnarzmTOc
    (10.09)

  • wayne

    Cotour–

    Good stuff.

    As bad as the healthcare taxes are, (and there are dozens of them, embedded into the ACA) if they don’t kill must-purchase, community-rating’s, and must-issue, it’s ALL just lies.

  • Cotour

    The continuing unknown here is Trump and how he will tend to drive and manipulate those that must be driven and manipulated.

    I believe that Trump is going to be a force to be reckoned with, totally asymmetrical and always a wild card and will as a rule mostly somehow get his way. What I am more concerned about is how the CIA, IMF, FED, Bilderberg, Russians, Chinese etc, etc will attempt to influence and manipulate the new president (read black mail). They were very successful with Obama, the people of America need resistance to these forces.

  • wayne

    Cotour–
    Personally, I’m not worried about the CIA or the IMF, I’m more worried about Rinse Prius as Chief-of-Staff, Johnny DeStefano as head of Personnel, and Mitch & Ryan in charge of Congress.
    I am worried about all the political-appointee’s who have been transitioning into the Civil Service the past 12-24 months. Those people, DJT can’t get rid of, no matter what he does.

    Jeb Bush must be smiling, low-energy or not, huge parts of his agenda are now represented in Trumps Cabinet.

    Finest Worksong
    REM
    https://youtu.be/559eWB93jW4
    (3:52)

    “What we want and what we need, have been confused… been confused.”

  • Cotour

    How about worrying about stuff like this:

    http://www.cnn.com/2016/09/23/politics/ohio-pennsylvania-election-2016-hack/index.html

    http://www.washingtonexaminer.com/homeland-eyes-special-declaration-to-take-charge-of-elections/article/2600592

    Seems that the set up was well planned out, although I do not believe that the states will stand for any of it if it were to become more than just noise. Will Obama dare to make some move in regards to this before he leaves?

  • Cotour

    http://thehill.com/policy/international/russia/313178-russian-official-us-democracy-was-undermined-by-obama-not-moscow

    I would more than likely to believe that Obama is the threat than the Russians.

    Now I do not particularly trust the Russians, that being said, this entire “hacked election” narrative that is being pushed by the Democrats, and John McCain, and Lyndsey Wagner (no, that was the bionic woman), John Podesta and whom ever else is very suspect to me, its just too convenient given the accompanying supporting documentation going back several months.

    They will plan to do and do anything in order that they retain power, how ever and what ever is necessary.

  • Mitch S

    I’m all for quick action on tax reform, immigration/security, etc.
    But there is no quick/simple solution for health care.
    The problems of Obamacare has deluded some into thinking that it is the problem with health care.
    But the healthcare system has been troubled back to Bill Clinton’s time – remember it was an issue in the ’92 election.

    Obamcacre is an attempted solution that made the problem worse. Remove it and there is still a serious problem.
    Trump/Republicans have to have something to replace Obamacare. Call it “Obamacare fixed” or “a better way’ but there has to be something.
    Suddenly withdrawing gov’t to let the market sort it out would be better in the long term but it’ll never happen because the disruptions will lead to Republican defeat before benefits can be realized.

    Better to take a step by step approach.
    The state by state “insurance” system is a mess (even before Obamacare). Dragging employers into providing health plans is inefficient, inflexible and confusing.
    The paperwork is overwhelming.
    There is way too much $ spent on ineffective or marginally effective meds.
    etc, etc

  • Cotour

    I am in the process of once again acquiring a new healthcare policy due to this situation. What am I going to do?

    1. Open a savings account or an IRA and over time fill it with money to the tune of about $10K, I will conservatively invest these funds and just let them sit.

    2. I am going to buy a bronze plan with a high deductible, $7 to $10K. This will cost about $350.00 to $425.00 per month.

    3. Eat my vegetables, look both ways when I cross the street, I gave up riding motorcycles many years ago for just this reason.

    This is what everyone at the foundation level should initially have as their healthcare. You can make it more complex if you can afford it. In the end if I stay healthy those funds over and above the $10K become accessible and are assets owned and controlled by me.

  • Edward

    Mitch S wrote: “Remove it and there is still a serious problem.

    There were only a few minor problems with healthcare. Outside of that, foreign dignitaries often preferred US healthcare over their own countries’ healthcare. Despite what Michael Moore said, even Cuba’s healthcare was not good enough for Fidel, when he had a stroke.

    1) Pre-existing conditions,
    2) High cost of a very few conditions,
    3) Crowded emergency rooms.
    4) Rising costs for various situations, such as overnight stays in hospital.

    Pre-exisiting conditions were handled by state-level high-risk pools. Obamacare may have made these pools obsolete, despite their continued need. Even many people with pre-existing conditions can’t afford Obamacare.

    Cancer and Heart disease are two conditions that can be costly. Of course, half a century ago they were pretty much death sentences, but just because their treatments are expensive does not mean that our healthcare system is a failure, despite what Micheal Moore would have us believe. The success is that they are now treatable, the trick is to figure out methods and treatments that aren’t so expensive. Even when there are incentives to reduce costs, it can take time, but right now there are no incentives.

    The ER problem was often due to illegal aliens attempting to get free medical care. Show up in the ER, get care, disappear without paying the bill. Since illegal aliens are exempt and forbidden from Obamacare, they continue to go to the emergency rooms, and this also explains why this problem was exacerbated once Obamacare took effect in January 2014.

    Added regulations contributed to rising costs — even before Obamacare — and so did huge liability insurance rates for doctors. Essentially, if you want to be a doctor in the litigious US, you have to be prepared to be sued at least once during your career. To counter these lawsuits, additional tracking, procedures, paperwork, and administrators were instituted, driving up the costs dramatically. Thus, a single aspirin tablet was billed at a price similar to the drug store price for an entire bottle of aspirin.

    In addition, the cost of the “free” healthcare to illegal aliens who disappeared after treatment had to be paid by someone, so it is paid by all the rest of us. The rising population of illegal aliens means rising costs to pay their unpaid bills.

    The rising costs also come from most patients having no concern over the costs. When employers are paying the insurance premiums, the employees and the families get what seems like free healthcare, but the rest of us have to pay for rising premium rates that are due to patients not caring how expensive their healthcare is and not shopping around for the best prices for the best services. When the patient spend other people’s money on yourself (e.g. you spending your employer’s money, or illegal aliens spending your money), then price stops being the patient’s concern.

    Somehow, a saved life became an entitlement. Go to the doctor, insist upon the best care available at your employer’s expense, and if your life isn’t saved then your family sues the doctor.

    The quick simple solution for healthcare is a free-market system, where we pay for what we want to get and don’t buy what we can’t afford, just like when we go to a store or to a restaurant. Some people are mistaken that we are entitled to all the best, but that is like insisting on eating surf and turf at every meal, living in a mansion and having several vacation homes (complete with servants and gardening staffs, and stables with horses, while we’re at it), driving Lamborghini cars, and flying in our own private planes (sound like any celebrities you know?). There is nothing inherently wrong with this lifestyle, but as with everything else, including healthcare, if you cannot afford it then you cannot have it.

    As Cotour said, above, that puts the responsibility on the individual to live a healthy lifestyle (also reducing costs for everyone) and to be productive enough to afford what he, the individual, wants to have — including healthcare.

    Personal responsibility and personal productivity. These are concepts that were made important here in America, but now seem to have become foreign in our land.

  • Cotour

    The concept of consequences and responsibility for life style choices is an abhorrent thought to those who would be charged with straightening this mess out. That does not mesh well with the culture of dependency and the accompanying control that goes with that culture. And its probably also racist (to someones mind somewhere anyway).

  • wayne

    Edward- Good stuff.

    Mitch S.–
    Understand & agree in some respects. (my hyperbole leaves out pesky details.) A transition-period would be required. The Feds are however, already funded through 2017, and industry needs lead-time.
    >>We didn’t get into this mess in a day, and despite my absolutist rhetoric, I do realize we can’t disengage literally overnight. Industry does need a clear message that Crony Healthcare is ending & they better start coming up with Plans to compete in a freer marketplace or go bankrupt. The Government Healthcare Establishment as well, needs to be reigned in, big time. Rome wasn’t burned to ash, in a day. I’m just highly leery of these clowns. They can’t help themselves.
    >Obama has stuck us with a huge mess. I just don’t want the Republicans to BLOW the one and only chance they have, right now, to do something correct for a change, instead of their typical gangster-stuff.

    Personally, I just want a clear, short, and concise “It’s repealed.” There has to be a solid end-point, or it will never go away. It will just morph into another ubiquitous government ‘thing’ and after a few years, it’s permanent.

    rolling stones –
    19th nervous breakdown
    https://youtu.be/9N6Oq8ZaBDU
    (3:49)
    -1966 Australian tv

  • Cotour

    Healthcare…………..is a right.

  • Garry

    Edward, you hit a lot of good points, but you didn’t explicitly mention one of the biggest results of doctors worried about getting sued: more and more unnecessary tests and procedures.

    In an ideal world (I know. . .) the doctor should be able to say “There’s a 99.8 percent chance these symptoms mean nothing, and the other .2 percent chance is something potentially dangerous [provide details]. We can run a test, which will cost you $1200, to get an idea (with 80 percent accuracy), of whether or not the other .2 percent applies. If you want the test, pay me the $1200. If you don’t, sign this document stating that you understand the situation.”

    Tests are big money. About 10 years ago my white blood cell count came in at 4.9, just below the 5.0 threshold (I later learned that until a month before, the threshold had been 4.0). My doctor ordered a bone marrow test, which was not a very pleasant experience. I don’t know how much it cost my insurance company, but it wasn’t cheap, as the extraction had to be conducted by a doctor.

    When the results came back, the doctor told me “Your test results are negative, you have nothing to worry about. I’m on a winning streak; I’ve sent about 200 patients for that test, and they all came back negative.”

    I found a new doctor within weeks.

    I later found out that the doctor himself owned the testing lab.

    That’s just anecdotal evidence, but more times than I can count, I’ve heard doctors (first hand or second hand) remark that they had to run tests to rule out some remote possibility. I think the patient should have more stake in running these tests, and make an informed decision on whether or not to take it.

  • Edward

    Garry,
    You wrote: “you didn’t explicitly mention one of the biggest results of doctors worried about getting sued: more and more unnecessary tests and procedures.

    You are right. I hid that away in the word “procedures,” but the word “tests” is far clearer as to what happened due to our litigious society. For instance, MRIs get ordered “just in case,” although on rare occasion the “case” is the case and further treatments are necessary to save lives. My recollection is that a lack of an MRI resulted in Natasha Richardson’s demise (actress wife of actor Liam Neeson). She had made an informed decision to not take that test. Sometimes you win; sometimes you lose. In this case, we all lost a fine actress.

    Garry wrote: “I later found out that the doctor himself owned the testing lab.

    Yet another way for US medical care to cost so much.

    I have a couple of friends who are doctors (MD). While one of them was still in school, we had a discussion about doctors owning or investing in test labs, specifically an MRI machine. I let her know in no uncertain terms that in the aerospace and defense contractor world, investing in a facility that we may, someday, have occasion to hire or recommend on a government contract is considered a conflict of interest. We can still own it, but we have to report the ownership or investment so that others can determine whether we are breaking the law by sending work their way.

    Doctors seem to not see the conflict of interest in such investments, and the AMA and government are not worried about such conflicts of interest. As Garry noted, he did not have to be informed that the doctor had an interest in the lab he was sent to.

    Apparently, what is sauce for the goose (MD) is poison for the gander (defense contractor employee). If only I weren’t so squeamish about blood and guts, I could have been a doctor who sent his patients to his own facilities. (“Well, it’s just the sniffles, but just in case, you need an MRI, full blood-work, and twenty-eight days in rehab.”)

    https://en.wikipedia.org/wiki/Wikipedia:Sauce_for_the_goose_is_(not)_sauce_for_the_gander
    Unfortunately, when the infighting here in Wikipedia gets heated, participants often forget this principle and do unto their opponents things that would not be fair to be done unto them, and sometimes add insult to injury by crying “foul” if their opponents do in fact raise similar objections to their own actions (and those of their friends) to the ones they raised against the opponents in the first place.

    Huh. Sounds like Wikipedia is edited by Democrats.

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