ObamaCare win turns up heat on GOP presidential field

ObamaCare’s victory at the Supreme Court is putting new pressure on Republican presidential candidates to map out a replacement to the healthcare law — a task that has eluded the party for more than five years.

With President Obama’s law twice affirmed by the nation’s high court, congressional Republicans now say a victory in 2016 is their best chance to tear down the statute and replace it with a GOP-favored alternative.

“I definitely think there will be pressure on these guys to put something out there,” said Lanhee Chen, the policy director for Mitt Romney’s 2012 presidential campaign. “They will need to have a plan.”

{mosads}However, few of the party’s dozen 2016 hopefuls have thus far offered concrete details about what their alternative to the law would look like.

Chen said Louisiana Gov. Bobby Jindal and Sen. Marco Rubio (R-Fla.) are “arguably further along,” in their planning, a point echoed by other experts.

Rubio’s plan includes giving tax credits to people to help them afford coverage and setting up high-risk insurance pools for people with pre-existing conditions. His plan is still in the form of an op-ed, and has not been fleshed out with details like the size of the credits and how it would be paid for.

Jindal’s plan — outlined last year in a 23-page document — centers on providing $100 billion over ten years in block grants to states that come up with their own innovative healthcare proposals.

That funding would also be based on how well states control costs like premiums and how well they ensure access to high-risk individuals, such as people with pre-existing conditions.

Jindal’s and Rubio’s plans are more developed than much of the rest of the field. Jeb Bush’s campaign referred The Hill to a blog post posted this week on Medium, which includes a half-dozen bullet points about a system to “empower states” but offers no specifics. He proposed a form of “tax relief” for premiums and a “conservative solution” for people with pre-existing conditions.

Wisconsin Gov. Scott Walker, another one of the party’s frontrunners, has also been mum on details, and his campaign did not respond to a request for comment on his replacement plan.

Asked on Fox News last week about his replacement plan, Walker mentioned letting the market “drive things,” giving consumers “full information” about their choices and allowing people to buy insurance across state lines.

The campaign of Sen. Rand Paul (R-Ky.) also did not respond to a request for comment. When asked how he would replace the law in January, Paul indicated he would largely return to the pre-ObamaCare system.

“We could try freedom for a while,” Paul told Fox News.

“Nobody’s talking about a time when the government doesn’t participate at all,” he said. “Even before ObamaCare, the government did take care of the bottom five or ten percent of our public, who were on Medicaid, and then there was also charity, so there are different ways that we take care and help the poor. Nobody’s saying we wouldn’t still do those things if we didn’t have ObamaCare.”

A problem for Republicans is that ObamaCare’s coverage expansion gets more ingrained with each passing year.

Tom Miller, who advised Sen. John McCain (R-Ariz.) on healthcare during his 2008 campaign, said he doesn’t expect any of the candidates to put forward a fully fleshed plan — because they don’t need to.

A promise to repeal ObamaCare remains a litmus test for the GOP, but Miller said it doesn’t mean that a Republican president would make it the first goal of their presidency.

The most likely scenario for a GOP president is a gradual phasing out of ObamaCare mandates, with help from Congress, to avert the chaos that would result from an immediate and complete repeal of the law, he said.

“You’re steering the ship in a different direction but it’s not going in a 180 degree change,” said Miller, a fellow at the conservative American Enterprise Institute. “No matter who is elected, it’s going to be slower and little bit more incremental.”  

Even so, any Republican president would need to act quickly, he warned. By the time the next president takes office, the law will have been in place for nearly seven years.

“You run out of time. Every year into the future makes it harder to go into a different direction,” Miller said, adding that he hasn’t yet endorsed a candidate.

The difficulty in drafting a replacement plan for ObamaCare became clear over the last six months as congressional Republicans scrambled to come up with contingency plans for the King v. Burwell ruling.

Like that decision, a full repeal of ObamaCare would cause millions of people to, at least temporarily, lose their subsidies.

Chen, the former Romney advisor, said that candidates have “guideposts” from two replacement plans, one from Rep. Tom Price (R-Ga.) and one from Rep. Fred Upton (R-Mich.), Sen. Richard Burr (R-N.C.) and Sen. Orrin Hatch (R-Utah). Both plans offer a form of tax credits, as ObamaCare does, but without the law’s mandate to buy coverage and same rules on pre-existing conditions and what a plan must cover.

After ObamaCare survived its last major legal challenge last week, Republicans acknowledge that full repeal is impossible with the president still in office.

Congress still has a few options to try to peel back pieces of the law — primarily, a legislative tool known as reconciliation that allows certain budget bills to bypass the Senate’s 60-vote threshold. Others are hoping to slash the president’s healthcare budgets through appropriation bills that make the law tougher to implement. But Obama wields the veto pen.

Several Republican presidential candidates in the last few weeks have said they are in favor of abolishing the Senate’s filibuster, which would help a Republican president repeal ObamaCare even if the party can’t reach 60 votes in the chamber.

That idea, though, has drawn opposition from one of the biggest ObamaCare critics in the 2016 field, Sen. Ted Cruz (R-Texas).

Walker, along with former Texas Gov. Rick Perry and former Hewlett Packard CEO Carly Fiorina, have all endorsed the idea, while Bush said he would “certainly consider” it during an appearance on the Hugh Hewitt show.

Still, there’s near universal consensus that the debate over full repeal will have to take place in the presidential debates.

“In 2016, we need to show the country what exactly we’d replace this law with,” House Ways and Means Committee Chairman Paul Ryan (R-Wis.) said on CBS’s “Face the Nation” after the ruling. “So that when we win the election in 2016, we have the ability to do it in 2017.”