The obvious Obamacare problem no one's talking about

Both sides acknowledge Obamacare can't be replaced or reformed without bipartisan buy-in. The problem is, for the moment, the two sides are too invested in partisan warfare to talk honestly. 

It’s the kind of innocent – and practical – question that someone outside of Washington might pose:

If it’s going to take a bipartisan solution to fix the Affordable Care Act – and leaders of both parties in Congress agree that’s what will be needed – then why not get that ball rolling now? Why not start the year with negotiations, instead of a fast-track to repeal?

But that is not what is happening in Washington.

Instead, it is political war over Obamacare, with dueling leaders – President Obama and Vice President-elect Pence – coming to the Capitol on Wednesday to rally their blue and red troops for the fight ahead. The working GOP assumption is that once repeal goes through, a transition deadline will force the parties to forge a compromise.

It’s an outcome that seems very hard – though not impossible – to imagine, given the reasons driving the conflict: a GOP campaign promise to repeal Obamacare and years of DEFCON 1 level messaging against it, and a Democratic president’s premier legacy at stake (not to mention health care coverage for more than 20 million Americans).

“We’ve had six years of the McCoys and Hatfields. It’s going to take some time” to work things out, said Sen. Lamar Alexander (R) of Tennessee, stepping into a Senate elevator crowded with Democratic women senators on their way to hear President Obama Wednesday morning.

Who 'owns' Obamacare now?

The president made a rare visit to the Hill, and behind closed doors he reportedly urged House and Senate Democrats to employ tea party tactics and storm town halls to save the law. Not only has the act greatly reduced the number of Americans without coverage, it has slowed the growth of costs for the 75 percent of Americans who have employer-provided insurance and raised coverage standards, Democratic leaders said.

Democrats are gearing up for a nationwide defense of the law’s benefits and are sounding the alarm over the dangers of repeal. They have chosen Jan. 15 as a national “day of action” to protest GOP budget and repeal plans that would affect not only the health care law, but also Medicare and Medicaid.

At the same time that Obama was speaking, Vice President-elect Pence huddled with House Republicans, then later appeared at the weekly Senate GOP luncheon. It is full steam ahead to repeal and replace, he said, with a two-track message that Republicans will fix the law’s problems while Democrats are to blame for its failures.

In advance of Pence’s visit, Donald Trump tweeted: 

Consumers participating in the law’s individual insurance marketplaces this year face skyrocketing premiums and far less choice among plans in many counties across the United States.

Race to repeal

Republicans have been working furiously on the repeal legislation, now aiming to get it to President Trump by Feb. 20. The Senate is now debating a budget resolution that sets Jan. 27 as the deadline to draft the legislation. The process requires only a majority vote in both chambers.

Republicans are also promising to replace the law – yet they have not consulted Democrats over repeal and replacement legislation nor have Democrats reached out to Republicans, according to a senior Democratic Senate aide.

Pence said Wednesday that he met with new Senate minority leader Charles Schumer (D) on Capitol Hill, but Democrats are promising to draw a hard line.

“If they want to talk about fixing and improving the law, we’ve been trying to have that conversation for years. If they want to break the health care system, that’s on them and they won’t get Democratic support,” says the aide in an email.

At a press conference, Senator Schumer said the onus is on Republicans to show them their replacement plan – then Democrats will talk. So far, Republicans have not agreed on a replacement.

In the meantime, Democrats believe they have a chance of stopping repeal in the Senate, as it would take only three Republicans to defect if Democrats remain united. 

“This is not pretend anymore. This is real life, with real consequences, for real people,” says Sen. Debbie Stabenow (D) of Michigan, of the consequences of repeal. Hospitals, doctors, nurses, and parents in her home state are “horrified that Republicans might actually do this,” she says.

While Senate Democrats may not be able to sway their Republican colleagues, “their own constituents could persuade them,” she says.

Republican concerns

Some Republicans, such as Sen. Susan Collins of Maine, are uneasy about going forward with repeal without at least having a detailed framework for replacement ready. Sen. Rand Paul (R) of Kentucky, went even further.

“I think it's imperative that Republicans do a replacement simultaneous to repeal,” Senator Paul said Wednesday on MSNBC’s “Morning Joe.” He warned against the disaster of insurance company bankruptcies if there is no new law to replace Obamacare.

That message has echoed in red state Arizona, where Republican Gov. Doug Ducey has said he does not want a repeal without a replacement.

Part of Pence’s message was that Republicans want a smooth transition until a replacement plan takes effect, and Trump will have executive orders ready to go to help stabilize a repeal transition period when he takes office.

But Republicans have put themselves in a tough spot, says Norman Ornstein, a longtime political observer at the center-right American Enterprise Institute. They have so maligned the law that compromise in fixing it will appear anathema to their supporters.

At the same time, “the fundamental structure of [the law] is theirs,” including the individual mandate, which was suggested by the conservative Heritage Foundation think tank in order to cover the costs of a high-risk population. Meanwhile, he says, some of their key solutions – from insurance across state lines to costly high-risk pools – are not workable.

When will real conversations start?

If they do succeed in repeal, will a transition deadline force the parties to compromise?

It could go either way, says Sarah Binder, a congressional expert at the center-left Brookings Institution.

In 2015, a GOP-led Congress proved it could pass significant, difficult legislation – from a long-sought highway bill to the reform of the No Child Left Behind law – despite severe polarization.

On the other hand, Congress is famous for kicking the can down the road – taking 12 years, for instance, to solve just one health-care problem related to Medicare known as the “doc fix.”

“When the parties see an incentive to bury the hatchet and come to the table, when it is in both parties’ political interest, no matter how contentious, how partisan [it’s been], they will come to the table,” she says.

But it’s almost impossible now to know what the conditions for negotiating will be later, Ms. Binder says.

“In the meantime, it’s messaging wars. That’s what it’s been and that’s what they’re used to.”