There Will Never Be A Republican Replacement for the ACA, Cont’d

Andrew Prokop has more on the utter disarray of the Republicans on health care:

When congressional Republicans went off to Philadelphia for a retreat this week, they hoped to make at least some progress toward a consensus about how to proceed with repealing and replacing Obamacare.

However, secret recordings of closed-door discussions at the retreat obtained by the Washington Post’s Mike DeBonis reveal that the party remains divided, uncertain, and deeply concerned about how to move forward.

It’s long been clear that there are a great many unsettled questions regarding the legislative and policy details of the GOP’s repeal effort. These include:

• How quickly should repeal go into effect?
• What, exactly, would the replacement be — can Republicans come up with a replacement that would be affordable for sick people who need insurance?
• Should Obamacare’s Medicaid expansion be repealed?
• Should the rest of Medicaid be transformed into a “block grant,” program as Paul Ryan has long supported, which would almost surely mean major reductions in the number of people it serves?
• Should an Obamacare repeal bill also defund Planned Parenthood?
• Does Donald Trump’s administration have a plan, or can his aides offer any more specifics about what they want policy-wise?

The Post’s report reveals that every single one of these questions remains completely unsettled, and that at least some within the party have grave concerns about all of them.

Republican House members representing blue states appear to be particularly worried. Rep. Tom MacArthur of New Jersey worried about pulling “the rug out from under” people covered by Obamacare, Rep. Tom McClintock of California warned that the GOP would own “the market we’ve created … lock, stock and barrel,” and Rep. John Faso of New York said defunding Planned Parenthood in a repeal bill would mean “walking into a gigantic political trap” that could end up with “millions of people on social media” protesting repeal.

Meanwhile, Trump’s top domestic policy staffer, Andrew Bremberg, is quoted speaking in only the vaguest banalities and broadest strokes, offering no substantive guidance whatsoever besides saying that HHS Secretary nominee Tom Price is a “compassionate” guy and a good doctor.

This was inevitable, because there’s no alternative to the ACA that 1)could get a non-trivial amount of Republican support and 2)wouldn’t be massively unpopular, because kicking millions of people off of insurance while making insurance much worse for many of those who still have it can’t be made popular. Having a clown without even the most basic understanding of the issues involved in the White House doesn’t help, but the fundamental dilemma would be there no matter what. The only remaining question is whether Republicans care strongly enough about inflicting large amounts of avoidable death and suffering on vulnerable people to help pay for upper-class tax cuts to take the political hit.

In related news, good stuff from Paul Waldman and Harold Pollock about why block-granting Medicaid would be horrible public policy. And read Michael Hiltzik on Aetna lying about its reasons for leaving the exchanges.