For Republicans, Partial Obamacare Repeal Carries Political Risks

Repeal of the Affordable Care Act is politically dangerous for Republicans unless they can pass a replacement that covers many of the people who benefit from the health care law.

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Donald Trump and congressional Republicans say repealing the Affordable Care Act is a top priority, but lawmakers might not be able to simply reverse the law without support from Democrats. Republicans could quickly push through a partial repeal of the law without that bipartisan support, but as NPR's Alison Kodjak reports, that comes with big political risks.

ALISON KODJAK, BYLINE: Senate Democrats are almost certain to use their filibuster power to block a repeal of the Affordable Care Act, so Republicans may have to invoke special budget rules that can circumvent the Democrats' opposition and defund the law. That would kill the parts of the ACA that Republicans hate most, like the requirement that everybody buy health insurance, but it could also leave many people who have coverage today without any coverage in the future.

RICHARD EVANS: Unless you replace that lost coverage, then you're almost certain to lose the Republican majority in the House in the midterm.

KODJAK: That's Richard Evans, head of the health care practice at the investment research firm SSR, who spoke to us via Skype. He analyzed the election to find out which House members won their seats by a slim majority and who also have a lot of people in their districts whose health care or jobs depend on Obamacare. A bill to repeal the ACA could pass even if about 23 Republicans voted against it. But in Evans' analysis, more than 23 Republican House members are vulnerable. And for those who are...

EVANS: That member of Congress is going to have to make a very tough decision and is in fact likely to lose their seat.

KODJAK: Evans' analysis shows a dozen or more who could fall into that category. In the Senate, lawmakers can repeal much of the Affordable Care Act with just 50 votes, but replacing the law would require the support of at least several Democrats to overcome a filibuster. Gail Wilensky ran Medicare and Medicaid under President George H.W. Bush.

GAIL WILENSKY: The upshot of that is that repealing may be easier than putting in the replacement.

KODJAK: And without a replacement, people could lose their coverage.

WILENSKY: There is not a willingness to have approximately 20 million people who have gained insurance as a result of the Affordable Care Act become uninsured. That would be regarded as a very bad political move, to be running in 2018 as the guys that took away insurance coverage from 20 million people.

KODJAK: But after six years promising to get rid of Obamacare, Republicans pretty much have to follow through, says Paul Howard, director of health policy at the conservative Manhattan Institute.

PAUL HOWARD: They have to take the vote. I mean, they can't help but take the vote because they've run on it so hard and because, you know, this is a major promise that both President-elect Trump and probably virtually every Republican serving in Congress has made.

KODJAK: Howard says the Affordable Care Act's partisan beginnings caused many of its flaws. Democrats in Congress pushed the law through on a party line vote, using the same budget maneuver that Republicans may now use to kill it. Because Republicans never supported it, they refuse to help fix its problems. Republicans now run the risk of making the same mistake if they follow a party line strategy to repeal the ACA, Howard says.

HOWARD: To put it bluntly, the shoe is on the other foot.

KODJAK: He says both sides now have to choose whether to work together to create a lasting health care reform or refuse to cooperate and continue to make voters on one side or the other angry. Alison Kodjak, NPR News, Washington.

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