Republicans Have Stopped Trying to Kill Obamacare. Here’s What They’re Planning

The prospect of a Republican resurgence in Congress raises the question: Where does the GOP stand today on health care policy — ACA/Obamacare, Medicare, Medicaid, private insurance and so much more? After a decade of ACA wars, do conservatives and Republicans have anything new to offer?

For the record, I was a U.S. Senate staffer involved in the crafting and passing the ACA during the law’s legislative process in 2009 and 2010 where I had the opportunity to get to know many of the GOP’s serious and thoughtful health care wonks.

Recently I reached out to and spoke with conservative and Republican health policy experts to understand their views about potential policy directions if Republicans take over the Senate and/or the House of Representatives next January, and perhaps the White House in 2025. What’s new? What’s left of the great white whale of Obamacare repeal? Do conservatives have fresh and challenging ideas? Are there break-out proposals being prepared or are they just repackaging old wine in new or old bottles?

Here’s what I learned.

The ACA Is Here to Stay

My conversations with analysts, activists, and observers showed zero appetite to take on ACA repeal again. “The Affordable Care Act is now embedded in our health care system,” Sen. Susan Collins (R-Maine) told the Washington Post in reaction to Johnson’s comments. “There are many improvements that can be made, but I do not foresee Congress repealing it altogether even if [Republicans] take control of Congress.” Collins was one of three Republicans whose 2017 vote against ACA repeal ended that effort. That vote included the late Sen. John McCain’s now famous “thumbs down” decisive gesture against repeal. More recently, Sen. Charles Grassley (R-Iowa) told an April 11 town hall in Iowa, “I’m saying I would not” vote to repeal the ACA.

Dean Clancy of the libertarian Americans for Prosperity grassroots organization told me: “Obamacare is here to stay, but we believe the law needs major improvements to deliver more personalized care for patients. We’ve had success in partially repealing controversial parts.” Among the successes he and other conservatives count include zeroing out the ACA’s Individual Mandate penalty in late 2017, repealing the much-disliked Cadillac Tax on high cost health insurance policies, eliminating the Medical Device Tax and repealing the Independent Payment Advisory Board that could have exercised broad authority to cut Medicare spending in ways that would have enraged hospitals, physicians and insurers.

National Review Editor Ramesh Ponnuru sees the elimination of these objectionable provisions as key to understanding today’s lower temperature on ACA repeal. “The most disliked sections that had motivated support for repeal have all been eliminated. The politics of Obamacare changed with the removal of those major pain points.”

Respected health policy expert Gail Wilensky of Project HOPE concludes that “the notion of repealing the…