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With the election of Donald Trump, Republican lawmakers finally have a repeal of the Affordable Care Act, better known as Obamacare, in their sights.
Despite holding control of the presidency and the legislature, a repeal of Obamacare may not come as soon as “day one” like leaders like Paul Ryan and Mitch McConnell have said.
According to Bloomberg’s Sahil Kupar, there is no consensus among Republicans as to when a repeal should take place, but GOP staffers are floating the idea of waiting until after the 2020 presidential election.
A number of the plans put forth so far by Republicans would feature a “repeal and delay” mechanism, in which a law is passed that “repeals” the ACA, but only goes into effect after a given period of time. This, the thinking goes, would give lawmakers enough time to craft a replacement and also avoid possible political fall out from a repeal.
Additionally, given that over 20 million people have gotten health insurance through various provisions of the ACA, pulling the rug out from under these Americans could be politically dangerous for Republicans.
The original “repeal and delay” plan that was floated in November would have delayed the repeal date until 2019, after the first mid-term election.
Obviously this move would carry significant risks. Politically, Trump could lose his re-election bid, thus denying the GOP a chance at repeal. From the market side, a long delay could cause insurers to pull out of the individual insurance market in anticipation of the move, destabilizing coverage for millions and causing prices in the market to soar.
Bloomberg also reported that Republicans are planning to present the current Obamacare law as failing on its own, thus making repeal more palatable despite the coverage increases.
Counter to this narrative, however, the Department of Health and Human Services reported last week that 6.4 million people have signed up for Obamacare exchange plans since open enrollment began on November 1— the quickest sign-up pace in the history of the exchanges.
Granted, premiums have increased significantly for 2017 and there are still too few young people on the exchanges, but the number of people signing up for the plans is not collapsing.
While the GOP could delay repeal anywhere between two to four years, the biggest challenge will be coming up with a replacement plan and while there have been a number of plans floated — from Paul Ryan’s Better way to Trump’s HHS pick Tom Price’s Empowering Patient’s First Act — a consensus replacement has yet to be reached.