Welcome to the Obamacare Repeal Expanded Universe

Republicans have a risky multi-stage process in mind to take down the health law.


credit—Jeff Malet Photography/Newscom

As House Republicans have rolled out their Obamacare repeal bill to widespread criticism, they have begun downplaying the importance of the legislation, saying that it is merely the first part of a multi-stage plan, potentially involving multiple bills and regulations, all of which will play a part in repealing and replace the law. "This is a three stage plan," Health and Human Services Secretary Tom Price said Tuesday, the same day that President Trump tweeted about "getting rid of state lines" in "phase 2 & 3" of the health care rollout.

Under this plan, rolling back the health law isn't so much a matter of a single bill as it is a sort of Obamacare Repeal Expanded Universe—a policy franchise that Republicans plan to execute over months or even years, the legislative equivalent of the comic book expanded universes that have taken over Hollywood.

There are reasons for this strategy, but also serious risks, and the GOP's adoption of this plan shows just how precarious the repeal effort is.

The main reason for the strategy is procedural. Republicans plan to skirt the 60 vote threshold in the Senate by passing their Obamacare repeal bill through the reconciliation process. That will allow them to pass a bill on a simple majority vote, but it also means that they can only address parts of the law with a direct budgetary impact—basically the tax and spending portions of the law.

But Obamacare is much more than taxes and subsidies. The bill also includes numerous regulations, including things like the law's essential health benefits, which require insurers to include certain coverage provisions. That's where step two comes in.

The second stage is to use executive branch authority to modify Obamacare's regulations—presumably in conjunction with new statutory language on the books following the Obamacare repeal bill. Under President Obama, HHS wrote thousands of pages of regulations governing the minute details of the Affordable Care Act's implementation; many of those regulations could be tweaked or unwound as part of this process.

Again, this is a team effort in which everyone plays a role: If the House and the Senate passing the repeal legislation are the Obamacare Repeal Expanded Universe versions of Iron Man and Captain America, the regulatory effort from the administration, which would likely be a joint project between White House senior staff and Tom Price's HHS, are something like Thor and the Hulk.

The final step, as always, is to keep expanding the universe as wide you can. That means going back to Congress where the plan would be to pass some unknown number of bills that would require 60 votes in the Senate. That, of course, means bringing Democrats on board. Right now, of course, Democrats in Congress are unified in opposition to any GOP health care plan. (They're basically running the same oppose-everything strategy that Republicans ran against Obamacare starting in 2009.) But once the repeal bill has passed, and the Trump administration has reworked the regulatory landscape, Republicans think they might have a chance to peel off Democratic votes because defending the Obamacare status quo won't be an option any longer.

That's the theory, anyway. But it's a risky one at best.

That's because it requires Republicans in Congress to trust that the Trump administration will swiftly and effectively execute regulatory reforms, which is dicey at best given a) how tricky and exhausting the regulatory process is under normal circumstances and b) the fact that neither Trump nor any of the senior staff seem to have any meaningful health policy priors—or even a basic understanding of how health policy works.

It also amounts to a bet that a handful of Senate Democrats will eventually play along. There is no reason to believe that they will do so. In fact, there is every reason to believe that they won't—just as Republicans did not make any real effort to engage productively with health policy until they were forced to, on the bet that politically it was better to stick to opposition only.

More broadly, the multi-stage complexity of the plan is itself a weakness, because it requires every single step to go right. If any one of them doesn't work as intended, the whole thing starts to get wobbly. That's particularly true of the first step, which provides the foundation for everything that comes afterwards.

Just look at what's happening to the expanded movie universe being built out of DC Comics characters: The plan was to create a Marvel movie universe style franchise, with at least half a dozen films scheduled over a multi-year timeline.

But the kickoff entry in the series, last year's Batman v. Superman (Man of Steel was really more of a prologue, like the 2015 reconcilation repeal bill), made enough money to be profitable, but was widely panned by critics, and fell short of expectations at the box office. The follow-up, Suicide Squad, was another box office hit, but the critical reception was even worse. Since then, the franchise has lost directors for several key films, and undergone a senior leadership shakeup.

Now look at what's happened to the GOP's Obamacare repeal bill: Reaction from the right and the left was broadly negative in the days after it was released, and there's enough opposition within the House, mostly from the right, that it is currently unclear if it can pass at all. Even if it does pass in the House, it still faces opposition in the Senate, largely from moderates would prefer a more generous bill. So modifying the bill to make it more amenable to House conservatives is likely to make it even less likely to pass in the Senate.

And this is only the very beginning of GOP's stage one. There's still a Congressional Budget Office score to come, and a potentially difficult negotiation with the Senate parliamentarian, among other challenges.

It's still too early to predict the eventual outcome with great confidence, but the rollout so far has been rocky to say the least. And the chaos so far doesn't exactly bode well for the rest of this policy franchise.

NEXT: Brickbat: How Do You Say 'Oops' in French?

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  1. It’s time that the GOP apologists (I’m looking at you, Sean Hannity) stop and take a long, hard look at how gullible they have been over the years.

    1. I’m sure John will show in the AM links, so why don’t you just tell him to his face?

      1. Listening to Hannity and Limbaugh is funny to me. They are such shills and are every bit as bad as CNN. They realized that polarized politics overrides their ability to be called out for their utter hypocrisy.

        Obama’s massive government, wars, entitlements, violation of the constitution and rights, and planned government waste was bad. When a republican does it, it is benevolent and tough. Sound familiar?

        1. In Limbaugh’s case, it’s been an open secret for a long time that he’s not actually conservative RL and is just playing a character on his show because it makes him millions of dollars.

          Hannity, on the other hand, is by all accounts a true believer, so it’s kinda sad to see someone who’s mind is that disconnected from reality.

          1. And that’s why the only guy I listen to is Mark Levin. Yeah, I thinks he’s crazy when it comes to the military and cops but he’s right a lot more often than he’s wrong.

          2. You might be right about Limbaugh, but could you provide a source for your claim?

    2. I don’t know how fair that critique is of Limbaugh and Hannity. I’ve heard them criticize the Republican party, esp. the leadership for years, and distinguish between the Repub party and conservatism. I think they view the Repub party as the only way to stop the Democrats, which is not completely unreasonable, even if the Repub leaders often say one thing and do another.

  2. Are they really going to keep going forward with this bullcrap?

  3. The main reason for the strategy is procedural.

    Funny, I would have guessed the main reason is because the GOP has been getting a lot of mileage out of flapping their lips about repealing Obamacare – just as they’ve been getting a lot of mileage out of beating their gums about making government smaller and cheaper and less powerful – and if they repeal it all in one whack, what campaign issue will they have to run on for the next 40 years?

    1. The act of repeatedly passing a repeal bill while knowing Obama would veto it, yet somehow not passing the same bill now would ignite lethal levels of shame and embarrassment to normal human beings. Truly, Republican lawmakers are superhuman!

    2. Indeed. The Obamacare repeal is the Harry Potter an the Deathly Hallows, Part 2 of our time.

      1. Except a billion times less popular.

  4. Has congress consulted Tony on this? They can find him at his mom’s house in some skinny jeans.

    He’s the one crying between fits of rage over the latest thing he was told to be outraged about.

    1. You people do nothing but bitch. Bitch bitch bitch. You’re outraged over the existence of basic aspects of civilizations. to quote John Stossel, give me a break!

      1. What do you mean YOU PEOPLE?

        1. Racist!

      2. So, you admit that you wear skinny jeans?

      3. You’re outraged over the existence of basic aspects of civilizations.

        Positive “rights” require others’ capital and labor, and therefore they require theft and enslavement. So, in Tony’s “civilization”, there is mandatory theft and enslavement.

        I don’t want anything to do with that “civilization”, how about you?

  5. the rollout so far has been rocky to say the least.

    “There’s no sugarcoating it.”

  6. Jobs report was released at 8:30 this a.m.

    “The U.S. economy added 235,000 jobs last month, according to the Bureau of Labor Statistics. The U.S. unemployment ticked lower to 4.7 percent.

    Economists polled by Reuters expected the economy to have added 190,000 jobs last month.

    Dow futures extended gains after the release, trading 100 points higher.”

    “If the question is when markets will recover, a first-pass answer is never.”
    — Paul Krugman

    1. Also, the best month of jobs added in 3 years.

      Admittedly, it would be hard to do as well as the Obama administration at strangling the economy.

      1. Hillary would have given the ‘ol college try.

    2. Yeah, but let’s wait until we see their inevitable downward revision.

  7. Republicans spent eight long years toiling in the dark, trying to find some way they could possibly make PPACA even worse than it already is. Finally, those efforts have come to fruition.

  8. So we have newly resurfaced evidence that once you create an entitlement, it’s basically politically impossible to take it away. How do you enact libertopia given this fact? Do you place your boots on the backs of the heads of everyone and just sort of slowly push their faces into the mud as you enact your glorious new “fuck you, I got mine” regime by some sort of totalitarian means? Cuz if it’s a strategy of elevated political discourse leading to the changing of hearts and minds, good luck with that shit.

    1. Reluctantly, I agree,Tony. About the best we libertarians can eventually hope for is that the tiny minority of individual rights lovers that are left can put a bullet in a slaver’s head before putting one in our own.

      1. Left after what? The affordable healthcare armageddon?

        1. No, the bottom of the slippery slope.

        2. No. he is referring to what is left of our formerly wildly prosperous capitalist country before the throngs of Tonys united under the guise of equality to join the collective and purge all of the producers and innovators from the earth.

          You see the black shirts get together because they are mad at contrived boogeymen and are inspired by the fallacious preaching of Marxists selling calls warfare as the problem that greedy rich people foisted upon benevolent hard working victims of exploitation. Once the Tonys of the world buy into the equality uptopia without rife corruption and bankruptcy, due to lack of the profit motive, the failures of the economy allow the tonys of the world to subscribe to violence against the moneyed class as a form of revenge.
          You see, you are a pawn of successful brainwashing. Worse yet, you got a 16 year education by the government mandate and now think you are smart.

    2. This is the new function of government. FUBAR whatever sector they take over, “fix it”, and pretend that it is now in a better state than prior to their colossal meddling. They create new dependents that will scream and wail for their teet no matter how broken, corrupt, and inoperable the “benefit” is. They got theirs.

    3. Reform is possible, but it usually requires massive amounts of pain inflicted upon the electorate before it happens. Fortunately for us, there are people like you out there hurting people more and more everyday. People like you create more reform minded people Tony, so please keep it up.

    4. You are going to bitch and bitch when Reagan/Thatcher 2.0 appear. I hope we’re all still here to see it.

  9. Obamacare was passed under reconciliation. Why can’t the repeal be done the same way?

    1. Obamacare got 60 Senate votes for the original legislation.

      Repubs know they can’t get 60 votes to repeal Obamacare this time around. So, institute RepubCare1 through reconciliation and regulation as the new baseline, then see if they can get 60 votes for RepubCare2 over RepubCare1.

  10. They aren’t getting rid of it. Like Ryan sneakily added in during his presser, “Obama screwed it up SOO bad that well we can’t go back to the way things were”. Government completely ruins an industry, but now that the colours changed, let’s trust the government to “fix it”, and try to force the previous functions of insurance into the memory hole.
    Looks like another government made bubble on the horizon that may burst in a decade.

  11. RE: Welcome to the Obamacare Repeal Expanded Universe
    Republicans have a risky multi-stage process in mind to take down the health law.

    Oh no.
    Don’t repeal Obozocare!
    How else can The State control the unwashed masses if not through healthcare?
    Nothing but bad will happen if The State can’t ration healthcare.
    Lenin said so.
    He never lied and only good things came out of the Soviet Union.

  12. Someone in the GOP needs to figure out how to explain to all the people with employer provided insurance how they would be better off if their insurance became taxable income. The explanation, as I understand it is as follows: If employer provided insurance is taxable income, employees will realize that it would be better to take higher wages rather than the “insurance” program that pays for non-drastic things. Then insurance operators would begin to provide much more reasonable insurance packages, which would lower the cost to everyone. The reason people with employer provided insurance want the grandest insurance program now, is that they are only indirectly (through lower wages) paying for it. Doing this levels the playing field with those who provide their own insurance, so no need for tax credits. But that is a bridge too far for the GOP.

  13. The Marvel Universe thing is just retarded. Oh, Suderman.

    The Republicans are doing what they can, under the law. Makes perfect sense.

    They know they won’t get any Dem votes in the Senate to overturn Obamacare. Therefore, overturn what you can without Dem votes, changing the facts on the ground so that Senate Dems would have to choose between new Republican status quo and a new Republican bill.

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