Obamacare: The Fantasy of Partial Repeal

by Ramesh Ponnuru

Former senator Norm Coleman, a prominent Romney backer, suggested that the full repeal of Obamacare was probably not going to happen but the law would see “major changes” if Republicans take the White House next year. A Romney spokeswoman said that while the candidate respects Coleman he disagrees with this assessment.

Getting Obamacare repealed will be very difficult. But it’s not clear what alternative Coleman has in mind, or could have in mind. Some Republicans have talked about getting rid of the law’s least popular provisions, notably the individual mandate, while keeping its most popular provisions, especially the command that insurance companies not take account of customers’ pre-existing health conditions. Coleman himself suggested that the courts might strike down the mandate and Congress might strike down IPAB (the Medicare cost-cutting/rationing board). But if the mandate goes, the insurance regulations have to go too: There’s no way insurance markets could work if you could wait until you were sick to buy insurance. The subsidized exchanges wouldn’t work either if people could jump on them when convenient. Take out IPAB, too, and all that’s left of Obamacare is the expansion of Medicaid. It’s hard to believe that you could build a legislative coalition to get rid of all of Obamacare except for that-especially since undoing that expansion would be key to any Republican bill’s claims to cut the deficit and thus to qualify for the “reconciliation” process needed to avoid a filibuster.

Obamacare could be tweaked by, for example, changing its funding streams. It could be moved leftward, through the introduction of a public option. Or it could be left alone entirely. Those are the options: Repeal, tweak, expand, or do nothing. Which option Republicans should choose is not a hard call.

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