Quote of the Day:

Democrats and liberal pundits were merciless in their critique of Republican efforts [to repeal ObamaCare]. As comedian Bill Maher put it, “The Republicans in Congress voted to repeal ObamaCare for a 40th time today. It’s really now less a governing philosophy, and it’s more like Charlie Manson applying for parole.”

–Tevi Troy and Lanhee Chen in today's Wall Street Journal

Actually, the GOP House passed more than fifty bills that would repeal all or portions of ObamaCare after their party took the House in 2010. They knew that a bill to repeal the Affordable Care Act was doomed by a veto if it got to the desk of President Obama.  

But now Obama is in the waning days of his presidency, and Tevi Troy, author, CEO of American Health Policy Institute and a former Health and Human Services deputy secretary and Hoover fellow and health care expert Lanhee Chen write that this much-mocked strategy paid off.

The write:

After Republicans won the Senate in 2014, the upper chamber worked with the House to repeal core provisions of ObamaCare via the budget process. This legislation reached President Obama, who vetoed it. The reaction was again dismissive: “It got them nothing, and with the stroke of a pen, the president dispensed with it,” said White House Press Secretary Josh Earnest. Yet Republicans had demonstrated a legislative path to repeal.

The accusation that Republicans have no plans for an appropriate replacement is false. The GOP has multiple plans, including House Speaker Paul Ryan’s “A Better Way” as well as plans from Sens. Richard Burr and Orrin Hatch and Rep. Fred Upton; Rep. Pete Sessions and Sen. Bill Cassidy; Rep. Tom Price, Sens. John McCain and David Perdue; Rep. Phil Roe and the Republican Study Committee; and Sen. Ben Sasse, among others. Add to this “Improving Health and Health Care: An Agenda for Reform,” the consensus health-reform plan by conservative scholars, including one of us (Mr. Chen), and it’s clear that the GOP has a plethora of plans.

Most of these plans focus first on driving down the cost of health care, expanding access to consumer-directed health arrangements like health-savings accounts, and replacing ObamaCare’s exchange subsidies with a refundable tax credit or some other tax benefit to help lower-income Americans afford health insurance.

The writers point out that before the Supreme Court’s King v. Burwell decision last year on subsidies via “state” run exchanges, Republicans were already getting technical advice on moving to create a health care system after ObamaCare. They wanted to know how to repeal and replace ObamaCare without ending health insurance for citizens who had acquired it under the law. Democrats mocked this, too, because they thought the law was going to stay. But Troy and Chen say that this prepared for the transition:

There was a logical and sequential aspect to these efforts. First, the GOP demonstrated that it opposed the Affordable Care Act, a law that last Tuesday’s exit polls showed 45% of all voters and 80% of Donald Trump voters felt had gone too far. Second, the slow but increasing levels of repeal success showed that the GOP was making progress toward its goal—and had a way to repeal without reaching a filibuster-proof supermajority in the Senate.

Troy and Chen suggest a method for repeal and replacement:

Once Mr. Trump and the new Congress assume office, we advise a four-step approach for repeal-and-replace. First, states should be given greater latitude through executive action to pursue aggressive reforms to Medicaid. Second, Republicans in Congress should move immediately to craft a budget resolution and pass it, thereby enabling the use of budget reconciliation legislation to repeal the law—as they did in 2015. Third, they should implement transitional reforms that would prevent potential disruptions in coverage gained under the Affordable Care Act, such as for those who benefit from subsidies for marketplace coverage. Finally, a more extensive replacement bill can then follow.

We should also take care to give a nod to all the activists and health care experts who didn't give up, even when they were told that either ObamaCare or ObamaCare plus (single-payer) was inevitable. There will be details to be debated, but patient-centered, market-oriented health care reform is on the horizon.