Senate Majority Leader Mitch McConnell has promised a swift repeal of Obamacare, one of Donald Trump's campaign promises as well. Congressional Republicans have worked out how to essentially gut it, even though they can't totally repeal it, without coming up against a Democratic filibuster in the Senate already, having passed a repeal bill through budget reconciliation, a bill that was vetoed by President Obama.
That bill, the "Restoring Americans' Healthcare Freedom Reconciliation Act of 2015," would eliminate Obamacare programs to provide Medicaid coverage for Americans near or below the poverty line. It would eliminate subsidies to help middle-income Americans buy their own insurance on new marketplaces. It would eliminate tax penalties for the uninsured, meant to urge everyone to obtain health insurance. And it would eliminate a number of taxes created by the law to help fund those programs. (It was written to kick in after two years, meaning the programs wouldn’t disappear immediately.)
We don't know, of course, exactly what legislation a new Congress would pass. And we can't be sure that the vote would go down the same way a second time. But last year's bill is a good template for what Republican leadership believes it can achieve through the special process. The Republican-led House has voted for dozens of total and partial Obamacare repeal bills. If we believe Donald J. Trump, who has vowed repeatedly to repeal Obamacare, he would seem likely to sign such a bill.
The reality of doing this is the reality that as many as 22 million people would then lose health insurance both through removing subsidies and by realizing their dream of dismantling Medicaid as it currently exists and turning it into a block grant, which states could then raid. But that could take a while and could come up against opposition outside of government. As Larry Levitt, health expert at Kaiser Family Foundation writes, there is "no precedent for unwinding a public benefit affecting as many people as the ACA." He makes another point: "Health industries have shifted their business plans in response to the ACA. This will be a turbulent and uncertain time for them."
That's echoed and expanded upon by Dan Diamond.
An unlikely Obamacare savior: The health care industry. With Democrats out of power, the industry that they've often lambasted may emerge as one of the only checks on Republicans' effort to roll back the law. Given that hospitals, drug makers and even some insurers have benefited from Obamacare's coverage expansion and other reforms, they could push the GOP to preserve some elements that favor them.
It's been a massive reengineering for many insurance companies, and they stand to lose a lot of customers (as well as a handy excuse for premium increases, before it was just greed and now they can blame Obamacare). They might just fight to keep their share of this pie, or some little slice of it. But any way you cut it, Republicans are going to do everything in their power to take health insurance away from millions. Congressional Democrats cannot be complicit in that.