Don't count Obamacare out just yet

David Beard

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Thursday November 10, 2016 · 4:05 PM PST

2016/11/10 · 16:05

WASHINGTON, DC - JULY 29: Sen. Susan Collins (R-ME), speaks during a hearing of the Senate Health, Education, Labor, and Pensions Committee which examines the reauthorizing of the Higher Education Act, focusing on combating campus sexual assault. (Photo by Astrid Riecken/Getty Images) — Republican Sen. Susan Collins, who voted against her party's last attempt to repeal Obamacare

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One of the many agonies of Tuesday night is the idea that much of President Obama’s work over the past eight years might be washed away by Trump and the GOP Congress. In some cases, there’s no doubt that will happen. But the biggest piece of Obama’s legacy, the Affordable Care Act, is not going to be as easy to kill as some are currently thinking.

To get rid of Obamacare, Republicans will need a bill to pass both Houses of Congress and be signed by President Trump (I know we all just gagged a little there, but we’re gonna have to get through it). If the Senate GOP simply brought a repeal vote to the floor under regular order, the 48 Senate Democrats would easily filibuster it to death.

More likely, they will bring repeal up through reconciliation, through which they can repeal most of the ACA with just 50 votes. (They could also just eliminate the filibuster entirely, so either way 50 votes will be the number.) No Senate Democrats have voted for repeal, so the GOP will start out needing 50 of 52 Republican votes. When this same bill came up in 2015, Republican Sen. Susan Collins voted against it, so they may already be down to 51.

At the time, other Republican senators expressed grave doubts about the bill before ultimately voting for it, with the safety of knowing that Obama would veto it and that the vote would be nothing more than a messaging tool.

West Virginia Sen. Shelly Moore Capito opposed including repeal of the ACA’s Medicaid expansion in the bill. In her state, 160,000 people have signed up for the expansion, almost 10 percent of the entire population. Alaska Sen. Lisa Murkowski almost voted against the bill as well (in her case because it included the defunding of Planned Parenthood) before ultimately relenting. Just those three senators could sink an outright repeal effort.

This doesn’t even take into account GOP senators who were happy to vote for a meaningless messaging bill but may balk at actually harming millions of people. Twenty-two Republican senators represent states where Medicaid has been expanded (and that doesn’t count Collins, since Gov. Paul LePage has blocked expansion). That includes Dean Heller of Nevada and Jeff Flake of Arizona, who will likely be facing competitive re-elections in 2018, and Cory Gardner of Colorado, who has to worry about 2020.

By no means am I saying that full ACA repeal can’t happen. As we’ve seen, never underestimate the American political system’s ability to make the worst thing possible come to fruition. And the pressure from the base of the party on the GOP will be intense. But it’s by no means a done deal, and progressive actions to save Obamacare in the coming months can make a difference.

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Don't count Obamacare out just yet

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