Time to call Republicans out (literally) on repealing the Affordable Care Act

The game is afoot. Today is a national call-in day to protect the Affordable Care Act. Tomorrow (Wednesday) Republicans begin voting on the budget measure that’s the starting point for their intended repealing of the Affordable Care Act. But — and this is major — Republicans may just be breaking ranks. Remember, they only need to lose three votes to make repeal impossible via their desired reconciliation method that avoids the prospect of a Democratic filibuster. And lo and behold, that’s looking increasingly possible. Rand Paul and some other Republicans have voiced their concerns about repealing the ACA without immediately providing a replacement. Five Republicans put forth a bill to delay the repeal bill by a bit over a month. Susan Collins and Lisa Murkowski are unhappy with the provision to defund Planned Parenthood. Some Republican governors are worried about the impact of repeal. And none of them are wrong. Repeal and delay would be devastating for the American people and economy alike. Let’s just say that I really hope you all have solid phone plans, because we need to be calling our representatives about this nonstop (cue Hamilton).

Let’s be clear on what precisely it is that drives Republicans wild about the ACA. I’m no psychoanalyst, so I’m not going to analyze the Republican psyche, although given the fact that the insurance legislation that Mitt Romney implemented as governor functioned as the precursor to the ACA, I have my own views. Bottom line, Republicans hate the ACA because it asks the healthy and wealthy (if not necessarily wise) to help support coverage for the elderly, the chronically ill, the disabled, children under the age of 26, and low-income folks. That’s it. Sounds a lot uglier when you put it that way, doesn’t it? It means throwing the most vulnerable Americans under the bus to give the wealthiest a tax cut. Which means that their replacement plans simply aren’t as good, because they don’t do the same thing as the ACA — namely, ensure that everyone who needs it has access to quality and affordable healthcare, because their plans don’t provide the necessary financial scaffolding.

Unsurprisingly, they do not yet have a replacement. Or, more accurately, they have a variety of possible replacements, but no consensus. And none that would actually please the majority of American people. None of their replacements would provide care on par with the ACA, and all pose a threat to the elderly and chronically ill people. As I explained before, in order to meet the budgetary requirements that allow them to repeal with a simple majority vote in the first place, they have to keep cuts to Medicare that would hurt even more people. How do they fix this? Good question. Maybe they’ll push the due date for the final repeal bill to March 3 instead of January 27th. Or maybe they’ll repeal in a piecemeal fashion, a sneaky move that could mean that they’d insert some of the provisions they want to repeal in Medicare or the Children’s Health Insurance Program authorizations coming up this year. That would put Democrats in a no-win situation, since they’d have to tank elements of these programs to stop Republicans from repealing important parts of the ACA. Or maybe it would be part of tax legislation. Bottom line, it’s not as much of a straight shot for the Republicans as they had initially thought.

They do, however, have the plan set forth by none other than Tom Price, the nominee for Secretary of Health and Human Services. His plan, ironically entitled the Empowering Patients First Act, is ready to go but presents serious problems. Sarah Kliff from Vox explained it as part of her excellent series on the ACA. If folks with pre-existing conditions don’t maintain continuous coverage for whatever reason (say they lose their job, or can’t work because of their illness, for example), then insurance companies would be permitted to charge them far more to purchase coverage. Basically, if you already have the misfortune to be sick, you’re screwed, but technically speaking insurance companies can’t refuse to cover you. Comforting, right? But Price may well face heightened scrutiny from Democrats because of “allegations of insider trading,” another factor that could harm Republicans’ momentum to repeal the ACA.

But could they even repeal and replace at the same time? New York Magazine explained that well, maybe not — at least not without Democrats’ cooperation. More Republicans are becoming increasingly wary of repeal and delay, which is their best bet to repeal the ACA. The reconciliation process allows Republicans to destroy the ACA, but not to establish a new healthcare delivery system. Repealing and simultaneously replacing is a whole different game of cards from repeal and delay. And Democrats wouldn’t support any legislation that fails to cover people as well as the ACA. So if repeal and delay goes out the window because just three Republicans defect, then that whole reconciliation process is a lost cause. No more repeal with a simple majority vote.

All of which is to say — charge your phone. Go out and get one of those rechargeable batteries. Program your representatives’ phone numbers as contacts in your address book. If an onslaught of calls could stop Republicans from eliminating the independent Office of Government Ethics, then it’s most surely worth giving that another go with millions of lives at stake.