by Mitch Kokai
Senior Political Analyst, John Locke Foundation
[M]uch of the debate within Republican ranks has its roots in fundamental disagreement about what an alternative to Obamacare should do. If two people or factions can’t agree about the ultimate goals of legislation, it shouldn’t be surprising to find them disagreeing on the policies to include in said bill.
For all the emphasis on the “repeal and replace” slogan since the day Obamacare passed Congress in March 2010, the current debate might be characterized as “repeal vs. replace.” Repealers focus more on eradicating the law, while replacers wish to make sure that an alternative does not leave many of Obamacare’s newly covered uninsured.
The repeal faction generally comes from the conservative wing of the party. It wants every word of Obamacare repealed — lock, stock, and barrel — and, in some cases at least, is willing to consider blowing up the Senate filibuster (a.k.a. the “nuclear option”) to do it. Repealers generally do not want to maintain many, or any, federal regulations on health insurance, deferring to the states (as was largely the case prior to Obamacare).
When it comes to alternative policies, some repealers don’t care about “replacing” Obamacare at all and would content themselves with a return to the status quo ante. Other repealers would focus more on enacting reforms to lower health-care costs rather than expanding coverage or providing subsidies to previous Obamacare recipients. …
… Whereas repealers want to eradicate the health law’s spending and taxes — to use the Washington lingo, they would return to the pre-Obamacare fiscal baseline — replacers focus on maintaining, or at least not eliminating, Obamacare’s coverage baseline. They would like an alternative to Obamacare to at least be competitive with current law when it comes to the number of individuals with health insurance — although for different reasons. Some replacers believe in the goal of universal health coverage, while others simply believe that an alternative, to be politically viable, must offer something to those currently covered by Obamacare.