“Repeal and replace” has been the GOP mantra since the Affordable Care Act, aka ObamaCare, was signed into law in 2010. Riding the wave of horror and outrage that inspired millions of Americans to rise up and rally, attend town halls, and become involved in the election process, the GOP has enjoyed enormous gains not only at the federal but at the state and local level across the nation.  They all understand how important this moment is to the Republican party, and they all comprehend that they have one chance to get this right.

What is not clear is how much they get about the need for substantive changes to those parts of ObamaCare they can tackle with only a simple majority in the Senate.  As the prof noted, they are somewhat restricted in what they can do unilaterally; without a supermajority in the Senate, there are parts of ObamaCare that cannot be “fixed” via budget reconciliation.

Major changes related to the power of the minority party in the Senate would have to take place, including the removal of the filibuster, a move that former Senate majority leader Harry Reid would almost certainly have taken had he felt the need to do so and one with which current Senate majority leader Mitch McConnell struggles (though I have little doubt that he, too, would take this rather extreme step and worry about the long-term consequences later).

What the GOP can do, however, without any input or support from Democrats is to tinker with the budgetary items of ObamaCare and those things Reid shoved through via reconciliation as budgetary matters.

What Speaker of the House Paul Ryan offered up this week is the House GOP proposal for the “repeal and replacement” of much of ObamaCare.  The problems with it are many, however, and each of the problems goes straight to the heart of the initial concerns of the Tea Party who rose up to challenge the government takeover of one-sixth of our nation’s economy, our health care/insurance system:  the federal government is still far too involved in health care, the taxes and penalties added are at least as onerous as those in ObamaCare (we’ll know more next week when the CBO report is released), and the central control of everything from what policies you can buy to how much coverage you must have are all in place.  They’ve simply applied lipstick to the pig.

Sarah Palin has provided the most concise “con” side to the replacement bill now making its way through the House:

“[R]emember this is government-controlled health care, the system that requires enrollment in an unaffordable, unsustainable, unwanted, unconstitutional continuation of government-run medicine, and even in this new quasi-reformed proposal, there is still an aspect of socialism. That’s the whole premise here.”

. . . .  Palin expressed serious concern with the fact that Ryan’s healthcare bill does not eliminate Obamacare’s individual mandate. It just shifts the mandate—which requires all Americans to purchase a health insurance plan even if they do not want one. Under Obamacare, those who do not comply, pay a tax to the federal government. Under Ryan’s plan, those who not comply, pay a fee to the insurance companies.

“This 30 percent additional fee will be collected by some in the private sector, which will mean politicians are allowed again to pick the winners and losers, and it makes you wonder who’s lobbying hardest for aspects of this new bill because obviously there are special interests involved. Otherwise, certain private sector segments of our economy wouldn’t be rewarded as they will be with this fee, instead of going to the IRS going to private companies,” Palin said. “It would be really helpful if every single one of these politicians would do like the NASCAR drivers do—and it’s been said before—but let them wear their sponsors plastered all over their three-piece suits when they show up so we know what side they’re on and who they’re actually doing their bidding for.”

Palin was among the first prominent Republicans to endorse Trump and remains a staunch supporter of the president.

Watch:

Palin goes on to discuss the massive role that central planning will still play in our health care/insurance system should this bill move forward.

. . . .  “But we can’t lose sight of the entire premise between the whole pro-Obamacare and the pro-RINO-care arguments,” she continued. “It’s so wrong because it’s still so unconstitutional. It’s still taxation without representation. It still picks winners and losers because some corporations get to opt out of the requirements that hit everyone else. It still infringes on states’ rights, and it still weaponizes the IRS against Americans who just simply seek freedom and choices and sensibility in their families’ health care. The IRS will be taxing aspects of this without representation because we have no choice. We’re shackled to politicians’ whims and special interests’ bullying interests, which does violate the Constitution, and it actually allows government to have a lien on our health.”

“People need to know it’s the foundation, it’s the premise,” Palin said. “I don’t know why we’re still even giving an inch on aspects of socialized medicine via this new RINO-care proposal. Is that okay with conservatives, with Republicans in office? They say they want the patient first. They say they want freedom. They say they want a free market to drive the insurance system that we have in America. But no, government is still in control. Government actually has a lien on our health because they lord over us penalties if we want to opt out of a big government mandate.”

Palin and the politicians she mentions are not the only people on the right who are confused by the big-spending, big-government “replacement” that Ryan is peddling.

Because whatever success ObamaCare can claim is almost exclusively grounded in the expansion of Medicaid and as such amounts to little more than the expansion of an entitlement, the concessions to that end in the GOP replacement are worrying.

The National Review reports:

[T]he ACA has increased insurance coverage by expanding Medicaid. In 2007, 18.1 percent of non-elderly Americans had public insurance. By 2010, that share was 22 percent, and rather than declining as the economy recovered, it continued to climb all the way to 25.3 percent in 2015.

The hue and cry on the left is that the Medicaid expansion will be removed by the GOP and leave millions without health insurance.  However, the GOP replacement does not do that at all.  Instead, it simply block grants that money to the states, and it does so without the eventual weaning of states from the federal dollars.

Indeed, the GOP version actually includes states that refused the ObamaCare Medicaid expansion in the new block grant of the expanded Medicaid, using— explicitly—2016 ObamaCare numbers for the grant amounts and expanding the payouts to all states.

The Washington Examiner explains:

The bill would keep Obamacare largely intact between now and 2020, and presumes that Republicans would have the political will to let spending cuts go into effect during a presidential election year.

Assuming they do, after 2020, it still makes allowances for enhanced Obamacare-level spending to cover individuals who signed up for expanded Medicaid by that time. And it replaces Obamacare’s subsidies to purchase insurance with a new federal subsidy scheme.

In addition, the bill introduces new spending that wasn’t even in Obamacare. For instance, it proposes $10 billion in “safety net funding” for states that did not expand Medicaid and $100 billion in spending aimed at stabilizing insurance markets. It used to be that Republicans believed that market forces were the best way to stabilize markets, not a massive injection of federal funds.

Because of all of this, it’s not clear to me that GOP leaders understand that we didn’t reject ObamaCare because it originated with Democrats or because Obama was in the White House.  Had these been the reasons, then sure, simply moving some numbers from one column to another and renaming things while keeping the core of the massive (unfunded) spending and central planning would be just dandy.

We did not, however, reject ObamaCare for partisan reasons or because we are racists; we rejected it because it was yet another powergrab that includes enormously expensive big government intrusion into our lives.  Because none of that has substantively changed in this new replacement offering, it’s difficult to see how Ryan’s effort gains the widespread support it would need to be successful.

President Trump has been tweeting his support of the GOP replacement for ObamaCare and has even threatened to back primary challengers of the bill because “repeal and replace” is a big part of the promise he made to the American people.  He has already established a clear track record of not only taking his promises seriously but of fulfilling them, impressive in a president who’s been in office for such a short time.

With all of the pressing concerns he must have, President Trump may not, however, be aware of the problems in the Ryan replacement bill, and to that end, Palin explains that she is certain he will step in and fix it.

“He will step in and fix it,” Palin said. “I have great faith that President Trump is one who will fulfill campaign promises. He already has a track record of doing so well in these first months, I’m just really proud to have been part of the constituency that wanted him in there and worked hard to get him in there. So, yeah, I’m sure that President Trump is going to do the right thing and listen to all sides, of course, but understand, especially, that as a businessman, he’s going to understand whether this makes sense in his vision of how to grow businesses and how to get government off our back and back on our side.

How will we create a smaller, smarter government with a proposal like this that basically allows for the continuation of a growth of government? That’s what any aspect of Obamacare or RINO-care does. So asking President Trump specifically about how running a business, not a Wall Street business, but mom-and-pop main street business, how does RINO-care help their business get to grow and drive and survive in this economy?”

It’s hard to see Trump answering those questions with “more government control and meddling” and “different onerous hoops to jump through, different government mandates, and different taxes and penalties.”  Like Palin, I sincerely hope that Trump will step in and get this thing revised to eliminate the fundamental problems that made the original ObamaCare so unpalatable to the American people.