The Republicans have put forth their plan to rollback Obamacare and the initial reviews are unfriendly. They plan to use a budget process called reconciliation that allows Republicans to avoid the 60 vote filibuster threshold in the Senate. While this makes it easier to pass, it limits the legislative action available to them. Because it doesn’t allow full repeal and replacement, the Republicans planned to enact their healthcare policy in stages. This first stage makes some significant changes to the law, but far less than its fiercest opponents demand. The major change is the elimination of the individual and employer mandate. It still requires insurers sell to anyone, but rather than the IRS penalizing citizens for lacking coverage, the law allows insurers to charge penalties to those purchasing without current insurance. Further, it freezes the Medicaid expansion and rolls it back in 2020. Beyond that, it repeals a bunch of taxes and reduces coverage requirements and restrictions.

The bill is in a politically precarious position, with major public defects from conservative groups and legislators. It scales back dramatically from a more ambitious bill vetoed under Obama. This one keeps the exchanges largely in place and tweaks rather than dismantles its regulatory structure. Some have argued that it is purposefully designed to not pass, which may play out whether intentional or not. Obamacare is in increasingly dire straits and so the argument goes that Republicans might be best off letting the law collapse in order to place pressure on Democrats. This would allow them increased leverage to enact wholesale change, while their current strategy creates an incentive for Democrats to resist any needed changes to the law. If repeal and replacement is to take place it will need to be done through legislation fully considered by the Senate. Republicans are taking a risk either way, but right now reconciliation is the only hope to make major changes in the current political environment.