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Republicans can’t answer basic questions about an Obamacare replacement — because they’re not serious about governing

Define “access.” Specify what you consider “affordable.” Tell us anything coherent about how it will work, what it will cover, what it will cost. These are not gotcha questions.

From left to right: President Donald Trump, Vice President Mike Pence and House Speaker Paul Ryan.
REUTERS/Jonathan Ernst

Why, exactly, do the Republicans and/or President Trump not have a plan ready to repeal and replace the Affordable Care Act, aka Obamacare? Are they serious about governing or not?

You can ask them, and they’ll say it’s in the works but isn’t quite ready for a detailed rollout. One of them even said they are “not congealing around ideas yet.”

If you press them, it turns out a real plan doesn’t exist. In fact, if there is anything beyond rumors that could be called a plan, the Republicans aren’t able or willing to specify much of what it will look like.

If you ask about whether certain specific provisions of the ACA, like the way it treats pre-existing conditions or the fact that insurers can’t set a lifetime cap on the amount they will cover, they express admiration for the value of those provisions without quite issuing a clear statement that they will be fully retained. It’s pretty basic stuff.

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If you press them even harder about what their plan will cover, how it will work, what it will cost, they will say that when it is implemented, every American will have “access” to health care that is “affordable.” (Here, I’m talking mostly about Speaker of the House Paul Ryan, for whom “universal access” and “affordable” are very key words in his every version of an answer. And those words sound good. But those words raise obvious further questions that have not been answered.)

You could say that everyone has “access” to Hamilton tickets, too. But unless you have a lot of money or really good connections, it might be years before you get to see the play. Is that how it’s going to work with your doctor?

To me, their magic words are less than nothing. Define “access.” Specify what you consider “affordable.” Tell us anything coherent about how it will work, what it will cover, what it will cost. Give us some clue as to how many people who have health insurance now will lose it. How many will pay less for something just as good? How many will pay more for something a lot worse?

These are not gotcha questions. There are obvious questions that must be answered so Americans can decide whether this big change the Republicans have been promising for six years will be changes for the better or the worse. Yes, liberals and Democrats and plenty of moderates and independents are biased against Republicans, or at least skeptical that they have a better plan. But that won’t get any better if Repubs keep talking about a better plan but never produce it. Where’s the beef?

Ryan is almost as good as Kellyanne Conway at keeping his cool and a smile on his face and talking as if he is answering a question. But when he (or she) is done, you will find you have not learned anything about the plan. (I almost said “if there is a plan,” but surely there is something at some level, of development). Still, the whole point of this post is: Why won’t they show it to us? Ryan and other leaders have begun to suggest that we won’t see it until 2018. 2018. They’ve been repealing Obamacare since 2011.

A small, silly, rhetorical war has erupted within Republican ranks about whether to “repeal,” to “repeal and replace,” or even just to “repair” the Affordable Care Act. Who cares? Tell us what’s in the plan. We won’t judge it on how much of the ACA is retains. We’ll judge it on whether, on balance, more people are helped than harmed.

The United States has long had a higher portion of its population without health insurance than any of the wealthy industrialized nations, which I consider to be a disgrace, or at least a serious problem (especially considering that we spend more, per capita, on health care than any of the others, even though we are far from the best in overall health outcomes).

Thanks substantially to the Affordable Care Act, the portion of Americans that have health insurance is currently at an all-time high. Will that percentage go up or down when the replacement plan is implemented? How much will costs go down and will anyone’s costs go up, and if so who, and if so how much? What will be covered and what, that is covered now under the mandates of Obamacare, will not be covered?

Since they took control of Congress, Republicans have voted dozens of times to repeal the Affordable Care Act (aka “Obamacare”). Why don’t they already have a replacement plan ready? Are they not serious?

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All of those repeal votes were just cheap political point-scoring, but it didn’t matter much because they could count on President Obama to veto the repeal bills.

Now, obviously, they have the votes to repeal, and a president of their own party, and whatever the system is after the dust clears, they will own it. If Americans who are now insured become uninsured, that will be a Republican accomplishment. If Americans find they are still insured but less well-covered than before, that will be on the Republicans. If most people are happy with the new plan, that will be a big step toward securing and extending their mandate into the future and other big issues.

President Trump will soon have some skin in this game. He has ridiculed the problems of Obamacare, but has also said more than once (I’ve written this before, but it may still surprise you because it is staggering) that under his plan “everybody’s got to be covered” and “ the government’s gonna pay for it.”

I’ll be very surprised (and impressed!) if those promises are fully kept. He has also said that his plan will be unveiled as soon as his HHS secretary is confirmed, which happened Thursday. 

Trump managed to get all the way through the campaign without putting out a detailed plan. He did give his plan a name: “Healthcare Reform to Make America Great Again,” and some provisions were mentioned but not at a level of detail that could be scored.

By the way, if you think I’m exaggerating the degree to which the Republicans are tiptoeing away from their big talk, here’s what Sen. Bob Corker (R-Tenn.) told a gaggle of reporters on Tuesday about the latest on a new health care program (as quoted in this Huffington Post piece):

“To be honest, there’s not any real discussion taking place right now…”  Corker told reporters. He said he has “no idea” when a replacement plan will be ready. “I don’t see any congealing around ideas yet.”

That’s pretty choice. No “congealing around ideas yet.”