Repeal took on various forms. The Republican-controlled House voted more than 40 times to kill the act. The Democratic-controlled Senate would have none of it. The GOP strategy shifted from “repeal” to “defund” — a process complicated by the fact that some parts of the act were already funded and states were using the money to set up insurance exchanges. (Alabama is not one of them.)
At the insistence of the Tea Party wing of the House majority, defunding was linked to raising the debt ceiling, setting the stage for a showdown that could hurt the economy and maybe even cause the United States to default on its debt.
Meanwhile, the only people who seemed to be paying attention to the “replace” part of the Republican promise was a group of House conservatives who were members of the Republican Study Committee. Frustrated by the failure of party leaders to come up with an alternative to Obamacare, they crafted one of their own. The RSC endorsed it and shortly it will be introduced in the House.
The very existence of an alternative plan is a victory for those in both parties who realize our current healthcare system is insufficient and expensive. While there are those on the right for whom “repeal” would be enough, closer to the center are Republicans determined to make it clear that they do not want the GOP to be branded the party of “no.”
The RSC proposes to get around the dreaded taxes and mandates by giving tax credits to individuals and families that buy insurance approved for sale in their states. It also included a commitment to cover the costs of high-risk patients, it guarantees people with pre-existing conditions will not lose their coverage, it makes health savings accounts more widely available, it allows insurance companies to sell policies across state lines, and it enables small businesses to ban together to seek better rates.
What it does not do is assure insurance coverage for millions of lower-income citizens who would be enrolled in Medicaid under Obamacare. Nor does it require insurance companies to allow parents to keep children on their insurance up to the age of 26.
Significant, however, is that now there are two proposals on the table — Obamacare and the Republican alternative.
Further examination will prove if the GOP version has legitimate merit. However, the Republican alternative could be a first step of a reform of Obamacare if there are enough in Congress in both parties willing to compromise. And that has been the problem from the start.