Mitch McConnell swore all through this campaign season that he wanted to repeal Obamacare,
"root and branch." Pretty much everyone, except the tea party base McConnell was relying on to get out and vote for him, have known since the Supreme Court
upheld the law in June, 2012 that this was not a realistic goal. Not once people actually started getting their health insurance through it. So the plan they'll have to settle on is to nibble away at it
piece by piece through the reconciliation process. Here's what that
probably means, according to the discussions Jonathon Cohn has had with experts and lobbyists: going after the things that are arcane or not terribly popular; the mandates; the medical device tax; the advisory board; and risk corridors.
As far as the individual mandate goes, that's an absolute non-starter. See this, the president in Wednesday's post-election press conference.
Obama: "The individual mandate is a line I can't cross."
— @ZekeJMiller
It should also be a non-starter for the insurance industry, which benefits tremendously from the captive market they now claim. Bottom line though, is that it would be difficult to hold the law together without it, it will be vetoed, and there aren't enough Republicans to override that veto.
For the rest of their options for repeal, head below the fold.
The employer mandate is a little trickier, and wouldn't be as devastating a loss to the structure of the law as the individual mandate. But it could still muck things up. As it stands, large employers—those with 50 or more employees—have to provide affordable insurance to their full-time workers (30 hours or more per week) or pay a fine. Republicans have talked about doing away with the mandate entirely or changing the hourly requirement to 40 hours/week. Since one of the arguments against the mandate is that employers will reduce hours for their employees at the 30 hour threshold, this change doesn't make a lot of sense. Doing away with the mandate entirely isn't necessarily a terrible idea though for those workers—they'd be eligible to purchase insurance on the exchanges. Breaking the connection between employment and insurance also isn't a bad thing for the future of the nation's healthcare system, either. But where this one fails—and points to the fact that Republicans' don't really give a shit about the deficit—is how much it will cost. The government will collect somewhere from $46 to $149 billion over the next ten years from the fines, and Republicans would have to come up with replacement funding.
The medical device tax repeal does have bipartisan support—Sens. Al Franken, Amy Klobuchar, and Elizabeth Warren are all supporters, because they've got device manufacturers in their states. Here's their problem: they've got to come up with the $30 billion over the next ten years that this tax on the manufacturers generates. From a political standpoint, these three should withdraw their support—it's not going to make or break their own political fortunes in their states. Providing any Democratic votes for any Obamacare repeal scheme is unacceptable.
The Independent Payment Advisory Board and the risk corridors have both provided great political fodder for Republicans—remember death panels and insurance company bailouts? That none of what Republicans said about either provision is actually factual doesn't matter, but at the same time repealing these provisions would be pretty much symbolic, and would really gain Republicans much toward crippling the law. The IPAB only kicks in if Medicare spending exceeds targets that Obamacare set. Medicare spending has been and is projected to be well below those targets—it's not going to happen in the foreseeable future. The risk corridors—paid by insurance companies into a fund that will reimburse other insurers who end up taking on more risk in the form of sicker, more expensive patients—just aren't a big deal (which is why Republicans never made a peep about them when they were included in President Bush's Medicare Part D expansion), except for those insurance companies who might need to be reimbursed for taking on a heavier load of sick patients. You can believe the insurance industry is going to want to hang on to this provision.
So, there are dangers for Republicans in all of these moves. The primary one being that they promised full Obamacare repeal to their extremist base, and at least a few potential Republican senators have their eye on 2016. To succeed in that presidential primary against Republican governors who don't have to vote on Obamacare, they need "root and branch." Nibbling around the edges as they are proposing won't satisfy the rabid base, and could very well piss off the insurance industry, which would still be having to comply with the law but without the guarantees they currently have.
Meanwhile, notice what no one in the Republican Senate is talking about? That's right—"replace" has completely disappeared from their agenda. That the Republicans are bankrupt when it comes to real policy ideas isn't news, but it's worth remembering. And bringing up at every available opportunity. And Democrats will have a lot of those opportunities when McConnell is bringing those bills to the floor.