ACA quandary

GOP Obamacare quandary — easy to hate, hard to kill

The repeal debate may fester in 2018 as Republicans split on strategy.

By JENNIFER HABERKORN

Republicans start the year divided over whether to tear down or prop up Obamacare, a split that could derail their legislative agenda leading up to the 2018 midterm elections.

GOP leaders on Capitol Hill don’t want a repeat of last year’s Obamacare fumble: They spent precious time on a failed attempt to repeal the health care law every member of the GOP was presumed to hate.

But they also don’t want to take repeal off the table, which would provoke conservatives who are still determined to undo Obamacare.

The reality is the GOP is so divided on Obamacare, they don’t have the votes to achieve either objective — repeal or stabilization. That means former President Barack Obama’s signature legislative accomplishment could keep limping along, crippled by the repeal of the individual mandate in the tax law but lifted by the surprisingly strong enrollment for the coming year.

President Donald Trump has declared Obamacare “over,” saying that axing the individual mandate means the health law is basically repealed. But he hasn’t made clear precisely what he wants Congress to do next. He's recently spoken favorably about a bill that would completely dismantle Obamacare and turn it into state block grants, as well as another measure that would shore up the Obamacare markets by restoring subsidies that he personally halted.

Nor is Obamacare the only health program the divided Congress must confront in 2018. The GOP is split over what other health and social programs should be atop its agenda, including whether to make another run at reshaping Medicare and Medicaid.

Republicans and Democrats alike promise to swiftly renew funding for the bipartisan Children’s Health Insurance Program — though they couldn’t agree on more than a short-term patch in December. Several Obamacare taxes take effect this year, though there’s bipartisan interest in delaying them. And the raging opioid crisis is driving a disturbing decline in U.S. life expectancy.

Yet it's the caustic politics around Obamacare — including the constant threat of repeal — that might be most politically nettlesome, particularly as GOP lawmakers try to show voters they can get things done before the midterm elections in November.

Just last month, the House blocked a Senate-led effort to fund the health law’s cost-sharing subsidies for two years — a conservative victory that underscores how loath they are to do anything that props up the health law, said Rep. Mark Walker (R-N.C.), who leads the conservative Republican Study Committee.

“You can see the difference on this side versus the Senate side as far as how much energy there is” for repeal, Walker said.

That rift could reappear almost immediately. Moderates — who say they have Trump’s backing — want to try again this month to fund those subsides, which help low-income people pay out-of-pocket medical bills.

Republican Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington say they will resume talks on the Obamacare payments with a goal of shoring up the health markets. Trump called Alexander in late December to encourage him to keep at it, the Tennessee Republican said. But even if he and Murray reach a new deal, the bill stands little chance of getting through the House without Trump’s public and consistent cheerleading.

“If they can get their heads together and President Trump endorses it, it will pass,” Sen. Roger Wicker (R-Miss.) predicted.

So far, House Republicans aren’t on board.

“Alexander-Murray is a really tough one, I think, in this chamber,” said Rep. Kevin Cramer (R-N.D.). House Republicans would want to add abortion restrictions, Cramer and other GOP lawmakers say, and they don’t want to send “bailout” money to insurance companies.

Meanwhile, Sen. Lindsey Graham (R-S.C.) is already working on resurrecting a fast-track procedural motion to pass the Graham-Cassidy proposal, which would tear up much of Obamacare and block-grant smaller sums to the states. It was the heart of a last-ditch repeal effort in September, but the GOP ran out of time and shelved the idea. Graham and Sen. Bill Cassidy (R-La.) argue the idea has promise because Sen. Lisa Murkowski of Alaska, one of three Republicans who voted against the repeal effort over the summer, was open to the idea of block grants as long as she felt her state’s interests were protected.

Graham argues that after repealing the mandate in tax reform — and thus weakening how the Obamacare market functions — Republicans have to live up to a “you break it, you buy it” contract with Obamacare.

“The Republican Party cannot avoid the obligation to replace,” Graham said.

But are Republicans crazy to try repeal again in 2018 with one less vote in the Senate — Alabama Sen.-elect Doug Jones is a Democrat — after spending nine months of last year in a fruitless effort?

“I think it would be crazy if you don’t,” Graham said. “How can you repeal the individual mandate and say we’re done? The thing’s going to crumble. We better find a replacement that works.”

But to dramatically shift the dynamic of division, Graham and Cassidy would have to be able to go to Senate Majority Leader Mitch McConnell with an ironclad promise of 50 votes for their Obamacare repeal.

A handful of moderate Republicans told POLITICO that they’d like to move away from Obamacare and on to legislation like infrastructure. But they don’t want to be quoted saying that repeal is dead.

And that’s the crux of leadership’s Obamacare problem. GOP leaders don’t have a solution, but they don't have an exit ramp, either; not after Republicans made repeal a central campaign pledge again and again for years.

Even McConnell, in his year-end news conference, said twice that he would love to uproot more of Obamacare, but indicated that it’s unlikely.

“I’d love to be able to make more substantial changes to Obamacare than we have,” he said. “As soon as we have the votes to achieve it, I’d like to do it.”