Vanity Fair reported a rift emerging within the Republican Party over how to dismantle President Obama’s signature health-care law without suffering the consequences at the ballot box. With public support for Obamacare at an all-time high, Republicans are struggling to craft an alternative that reconciles a number of extensive promises Donald Trump has made—that no one will lose coverage under his plan; people with pre-existing conditions won’t be denied coverage; that the Medicaid expansion under the A.C.A. won’t be rolled back—with classic conservative principles, namely lower taxes and smaller government. But these challenges may prove intractable. And as Republicans’ simple “repeal and replace” narrative has grown more complicated, some conservatives are beginning to worry that the window of opportunity to kill Obamacare is closing.
Hard line conservative Republicans want a repeal without any replacement. While Paul Ryan’s “plan” would utilize the budget reconciliation process to pair repeal with several stop-gap replacement provisions, members of the Freedom Caucus are advocating a pure repeal bill—similar to one that passed both houses in Congress in 2015—creating a sort of “Obamacare cliff” that would leave lawmakers with little choice but to come up with a quick alternative. A few reasonable Republicans understand that would be political suicide.
At the root of the growing divide G.O.P. divide is the fact that, despite having railed against the Affordable Care Act for seven years, the party is no closer to rallying around a replacement plan.
“If we just passed what we did in 2015? Nobody is seriously proposing that because it doesn’t have any replacement,” Lamar Alexander, the Senate Health Education, Labor, and Pensions chairman, told Politico, highlighting the greatest source of tension that has emerged between congressional Republicans and constituents. The G.O.P.’s failure to identify an alternative to the A.C.A. has put the party on the defensive, as uncertainty over the future of the $3 trillion health-care industry has gripped the country.