The other Insane one...

Cruz's missing Obamacare replacement plan

No one doubts he would take apart the health law. What comes next is the question.

By Rachana Pradhan and Paul Demko

Everyone knows how Ted Cruz feels about Obamacare. He’s the guy who shut down the government in a bid to kill it — and should he reach the White House, he’d take a blowtorch to the law.

But Cruz isn’t very clear about what — if anything — he’d do to replace a law covering 20 million people. And some establishment Republicans suggest that he address this head-on before the pivotal April 5 primary in Wisconsin, where Republican leaders have been more aggressive in fleshing out alternative health plans.

Cruz raised his political profile by defying the Republican establishment to force the government shutdown over Obamacare more than two years ago. But as he approaches the winner-take-all Wisconsin primary — which may be the party’s best chance to prevent Donald Trump’s nomination — he needs to court voters who’ve elected politicians like House Speaker Paul Ryan, a policy wonk who’s called on his party to offer a replacement plan.

“I think it would benefit [Cruz] as a candidate, period, but especially in Wisconsin," said Brian Fraley, a Republican strategist who describes himself as a “Never Trump” voter who plans to back Cruz in the state’s primary. "The insurance industry is big in Wisconsin. The health care industry is big in Wisconsin. This is a race where every brick helps in the foundation.”

Cruz, who in 2013 spent roughly 21 hours straight on the Senate floor voicing his disdain for Obamacare, hasn’t detailed how he’d expand coverage or extend Obamacare’s insurance protections like covering people with pre-existing conditions — protections that remain popular even as the country is split on the health care law.

He’s hardly alone. Republicans have struggled to articulate an Obamacare replacement plan during the six years since the law’s passage, despite regular promises to do so. But Cruz's scorched-earth approach to Obamacare repeal puts him at odds with Wisconsin Gov. Scott Walker, who offered a replacement plan last summer before his presidential campaign flamed out. And Ryan has said there’s an “urgent” need for the party to offer a replacement plan this year.

“As leaders, we have an obligation to put our best ideas forward — no matter the consequences,” Ryan said in a high-profile speech this week. “With so much at stake, the American people deserve a clear picture of what we believe.”

Ryan, who will chair the GOP convention in July, is remaining neutral in the race. Walker plans to endorse a candidate soon and has said Cruz is the only one who could block Trump’s march to the 1,237 delegates needed to secure the nomination. A victory in Wisconsin, which appears to be a wide-open race, could net Cruz the vast majority of the state’s 42 delegates before a series of contests in Northeastern states where he’s not expected to do well.

Few can claim they’ve gone to the lengths Cruz has to scrap the president’s signature domestic achievement. A landmark moment of Cruz’s brief Senate career came in 2013, when his ill-fated effort to defund the law precipitated the first government shutdown in nearly two decades — and angered establishment Republicans, who accused Cruz of waging an unwinnable fight just to help his own standing with the party’s base.

He’s steered clear of other replacement bills that Republicans have circulated over the years that never gained traction. When a Supreme Court case last year threatened Obamacare’s insurance subsidies, Cruz offered a replacement bill that primarily would have allowed health insurers to sell plans across states lines — an idea long favored by Republicans that hasn’t had any success in limited, real-world practice.

Cruz’s struggle to explain his Obamacare replacement during an Iowa town hall in January produced one of his campaign’s worst moments. A voter who said his late brother-in-law was able to obtain coverage only because of Obamacare pressed Cruz on his health care replacement — but Cruz stuck to his standard anti-Obamacare talking points as the voter fought back tears.

“I’m pointing out, there are millions who had health insurance, who liked their health insurance, and who have had it canceled because of Obamacare,” Cruz said in an exchange that was covered widely. “So there are millions of stories on the other side."

Cruz went on to win the Iowa caucuses days later.

To be sure, Cruz has discussed boilerplate GOP health care policies in the Senate and on the trail that he says would lower insurance costs and allow more people to purchase coverage without the threat of a federal mandate.

In a January debate, he emphasized interstate insurance sales, expanding the use of health savings accounts and allowing people to carry over coverage when they switch jobs.

“I think that's a much more attractive vision for health care than the Washington-driven, top-down Obamacare that is causing so many millions of people to hurt,” he said.

Cruz’s campaign did not respond to questions about whether he will present a more detailed Obamacare replacement plan, or who is advising him on health care. It’s unclear how much the ideas he sketched out would cost, or how many people they would cover.

“He’s got to articulate not just repeal, but what is the center-right health care system that he’s defining as the future of health care?” said David Winston, a Republican pollster who advises GOP leaders in Congress. “Everyone needs to define what the alternative is. I think it’s incumbent upon all candidates to do that.”

Some Obamacare critics who’ve urged Republicans to keep up their fight against Obamacare said Cruz is missing an opportunity to draw a clear distinction between himself and Trump.

“One of the defining decisions the rest of the way in the Republican race is whether Cruz decides to put out a full-fledged alternative and really vaults Obamacare to the center of the race,” said Jeffrey Anderson, a senior fellow at the conservative Hudson Institute think tank. “It’s always seemed like it could be his best issue, but by not putting out an alternative he’s been unable to capitalize on it.”

Endorsing any specific plan comes with political peril — it offers a bull's-eye for opponents. Trump’s high-level health care proposal was skewered by the Committee for a Responsible Federal Budget, a Washington-based think tank that said his plan would add hundreds of billions to the federal deficit and insure a tiny fraction of those covered by Obamacare. And the three Republican candidates who offered detailed Obamacare replacement blueprints — Walker and former Govs. Bobby Jindal and Jeb Bush — failed to gain any traction in the race.

The takeaway for the remaining presidential candidates may be that sticking with the Obamacare red meat is better than getting bogged down in specifics.

“The safe rhetoric has yet to move beyond repeal and replace for these guys,” said Terry Holt, a Republican strategist who worked for John Kasich when he chaired the House Budget Committee. “Better to keep your powder unless you want to blow up the anti-ACA coalition.”