Reuters

Republicans have wanted to repeal President Obama’s signature piece of legislation, the Patient Protection and Affordable Care Act, for quite a while now. In fact, they’ve been introducing legislation in Congress to repeal ‘Obamacare’ since the day Obama first signed the healthcare bill into law. At the time they railed against the individual mandate included in the plan, an idea which originated decades ago in a conservative think-tank — The Heritage Foundation as an alternative to reach universal coverage without single-payer healthcare.

Obama had genuinely planned to find bipartisan support for his bill, which was largely based on a plan that had been crafted using bipartisan ideas in Massachusetts and was signed into law by the state’s Republican Governor, Mitt Romney. Mitch McConnell quickly realized that he could throw a wrench in that plan by simply refusing to cooperate no matter what, so Republicans proceeded to lob Reagan-esque insults at the legislation for the next eight years as millions more Americans signed up for health insurance, framing the ACA early on as a “big, federalized, bureaucratic, government-run, kind of nanny nation approach”.

Now here we are at the end of Obama’s second term, and roughly twenty million more Americans have health insurance thanks to the Medicaid expansion, new marketplaces, and changes to private insurance put in place by the ACA. Having now won control of the White House and both chambers of Congress, Republicans suddenly find themselves caught in the awkward position of continuing to parrot their cynical party line on Obamacare while also having to propose the ‘better, cheaper solution’ they’ve claimed to have up their sleeve this whole time.

This, of course, begs the question that Obama has jokingly asked of why they didn’t offer their solutions any time over the past eight years — while also revealing that Republicans do not, in fact have a consensus plan to replace Obamacare which won’t take health insurance away from Americans and will cost less. (Or they do, but they’re just keeping it a secret for some reason.) Top Republicans have made suggestions here and there, such as Paul Ryan’s idea to cover pre-existing conditions via ‘high risk pools’, but as a whole they are nowhere near forming a comprehensive piece of legislation that will maintain coverage for those who have gained it through the ACA — let alone one they can get through Congress.

The debate is now centered on the question of whether they will “repeal, then replace” or “repeal and replace”, with roughly eighteen million Americans’ health insurance hanging in the balance, according to an analysis by the non-partisan Congressional Budget Office. If they repeal the law without a replacement, Republicans risk stripping millions of health coverage and effectively signing their own death warrant as a party, as well as the death warrants of those who will die without healthcare. If they can’t reach a consensus on a replacement right now, in the honeymoon of a new Presidency with the most political capital they’ll likely have for a while, then it’s highly doubtful they ever will. Even Trump seems to understand that, as he’s asserted that an Obamacare replacement could come within the “same hour” as the repeal. Whether Republicans follow through remains to be seen, and it’s clear that a lot is riding on their ability to keep their promises.