President-elect Donald Trump made repealing and replacing Obamacare, which passed with only Democratic support, one of his major campaign themes. But he and Republicans in Congress will face a number of challenges trying to fulfill that pledge.
Six challenges in particular loom for vigilant and thoughtful lawmakers:
Republicans retained their Senate majority, but they do not have the 60 votes necessary to end a filibuster. So unless they can persuade some Senate Democrats to join them — or unless Republicans eliminate the filibuster — Democrats could block the measure, making full repeal almost impossible.
Senate Republicans can repeal important parts of Obamacare through the reconciliation process — those relating to tax and budget issues — because that only needs 51 votes. (The new Senate will have 52 Republicans.) But some parts, such as regulations, would remain.
Many Republicans, including the president-elect, now embrace some of Obamacare’s provisions — for example, prohibiting insurers from denying coverage and allowing children to stay on their parents’ policy up to age 26. But those mandates are what’s making Obamacare so expensive and unworkable.
Many Republicans are worried about the political fallout from ending 20 million people’s health coverage — even though Democrats weren’t concerned about the millions who lost their coverage because of Obamacare.
The left and the news media will complain that repealing Obamacare will increase the number of uninsured and health-care spending.
And perhaps the biggest challenge is that Republicans are divided — and have been for the past six years — over what to replace Obamacare with and how to implement that change.
Repeal-and-replace could be a minefield. As Politico reports, smart, politically attuned congressional Republicans are already scared of the implications. But they need to get started immediately to fulfill that oft-made campaign promise.
Merrill Matthews, author of “Ten Steps to a Market-Oriented Health Care System,” is resident scholar of the Institute for Policy Innovation, a conservative think tank based in Dallas.