Senate Majority Leader Mitch McConnell famously promised to rip out Obamacare “root and branch,” a sentiment echoed by Republicans on the campaign trail for seven years.

But Obamacare is proving harder to eradicate than kudzu, and Republicans may be stuck with major parts of Barack Obama’s legacy.


The current Senate repeal bill retains more of the law than most could have imagined when their efforts began six months ago, including popular provisions that allow young adults to stay on their parents’ plans until they turn 26, protect Americans with pre-existing conditions and subsidize the cost of coverage for low-income Americans, a linchpin of the federal health care law.

To the consternation of conservatives, Republican leaders may even keep some of Obamacare’s taxes — a position that would have been considered apostasy not long ago.

“How many of the regulations are they actually repealing outright in the bill?” asked Chris Jacobs, a conservative health policy analyst who writes extensively about the GOP repeal efforts. “I don’t think any. If we’re not repealing root and branch these 20,000 pages of regulations, what are we doing?”

“They just sort of keep watering it down and watering it down until they can get everybody to say OK,” said James Capretta, a conservative health policy analyst who worked in the White House under President George W. Bush.

Which raises the question bedeviling McConnell: Can the party actually unite around a bill that critics denigrate as “Obamacare lite”? Senate Republicans have already pushed back a possible vote for another week, until mid-July, while they negotiate possible changes.

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Anything short of full-scale repeal will enrage the GOP's base supporters, and potentially spark primary challenges from the right. Conservative advocacy groups like FreedomWorks and the Club for Growth are already pressuring McConnell to make the Senate repeal bill more conservative by allowing insurance customers to opt out of Obamacare’s coverage rules if they choose to.

“They were elected on the basis of repeal, not repeal and replace,” said Jack Rogers, a longtime tea party leader in Minnesota. “Do the job you were elected to do and don’t lie to us.”

But ripping away health care from the roughly 20 million who have gained coverage under Obamacare risks antagonizing a much broader swath of the electorate. The Affordable Care Act’s increasing popularity — rising above 50 percent approval for the first time ever in recent polls — is a warning flag to Republicans.

“They presumed that they could pass a clean repeal bill like they did in 2015,” said Capretta. “That was just never going to work politically.”

Sen. Rand Paul, one of the sharpest critics of the current Senate bill, suggests the only way to reach consensus is to offer separate repeal and replace bills. Despite President Donald Trump’s shout-out of the idea last week, even Paul acknowledges it has gotten tepid support from other senators.

“That way everybody gets what they want,” Paul said before the recess. “You take stuff that the moderates in our caucus want, stick it in another bill that Democrats love and will vote for. Boom, you’ve got what you want.”

Obamacare’s backers hardly agree that the GOP repeal bills merely tinker around the edges of Obamacare. They point to the CBO findings that at least 22 million fewer individuals would have coverage in a decade as evidence the Senate bill represents a fundamental unraveling of progress made over the past seven years. And while the bill maintains Obamacare's subsidy structure, the benefits are less generous and don’t include the law's assistance to reduce out-of-pocket costs.

But most of the coverage losses come from roughly $800 billion in Medicaid cuts. And the most dramatic of those changes come so far down the road that many health care experts question whether they’re likely to ever be fully implemented.

“Everybody is concerned,” about the Medicaid cuts, said Greg Scott, who oversees Deloitte’s health plans practice. “Some are less concerned because they think this will be political kick the can in a few years.”

Protections for individuals with pre-existing conditions are emerging as the crucial issue in the standoff over how thoroughly to gut Obamacare. Key lawmakers like Sens. Bill Cassidy of Louisiana and Bob Corker of Tennessee have identified the issue as essential to any package they can support.

“There is no attempt whatsoever to do away with” pre-existing condition protections, Corker told a constituent in Tennessee on Thursday, in a video posted online.

But conservatives have identified loosening those protections as crucial to one of their main goals: bringing down premium costs. They fear that any plan that maintains Obamacare’s coverage rules would do too little to address those costs.

“We don’t have the courage to address that guaranteed issue, pre-existing condition, head on,” said Sen. Ron Johnson of Wisconsin last week, citing the experience of a healthy, 62-year-old constituent whose premiums have skyrocketed under Obamacare. “I can’t tell you how frustrating that is.”

Sens. Ted Cruz of Texas and Mike Lee of Utah are trying to thread the needle between the two camps by floating a proposal to allow insurers to sell two sets of insurance plans. Under their plan, any insurer that offers coverage that meets Obamacare’s requirements would also be allowed to sell noncompliant plans.

The skimpier products would likely be cheaper and prove attractive to younger, healthier customers, but many health care finance experts question whether such a bifurcated market would prove viable. They say that healthy people would likely buy the cheaper products, while older and sicker consumers who need expensive drugs and procedures stick with the Obamacare-compliant plans — making those plans even more prohibitively expensive.

Dean Clancy, a conservative health policy analyst whose résumé includes stints with FreedomWorks, as well as the White House and Capitol Hill, believes Republicans are likely to eventually coalesce around an agreement. But he doesn’t believe that will happen before they adjourn for the August recess.

“Repeal is definitely in the rearview mirror now,” Clancy said, “and replace is hanging onto the back bumper by its fingertips, and probably is going to fall off. And what we’ll end up with is repair or fix.”