Repeal and Replace, Whatever That Means

Seven years after a Democratic-majority Congress passed President Barack Obama’s Affordable Care Act over tooth-and-nail Republican opposition, President Donald Trump stood before a Republican-majority Congress and declared: “Tonight, I am calling on this Congress to repeal and replace Obamacare.”

In a speech that even some of his critics called upbeat and presidential, Mr. Trump urged that unity be given a chance, as he turned to the Democrat side of the chamber and asked: “Why not join forces to finally get the job done and get it done right?”

Yet even this traditional pitch for unity could not move the Democrats from their stony silence. Republicans stood and cheered while the Democrats remained seated, a scene repeated a number of times during the speech when the president touched on such issues as immigration and defense spending. (A trillion-dollar proposal for infrastructure did elicit their applause, though.)

There is no indication that any of the Democrats are considering voting for a change in Obamacare. Certainly not those who boycotted the speech, nor those who wore blue “Protect Our Care” buttons, nor those who left immediately after the speech, disdaining any polite handshakes with the president. Rep. Earl Blumenauer (D-Ore.), summed up the liberal response in two syllables of militancy: “Resist.”

President Trump asked the Democrats to join him in a unified effort, but he might as well have addressed his appeal to the deeply divided Republican party, as well.

They were looking foward to Tuesday night’s speech, hoping that the president would set forth a clear health program that would help resolve the schism between the moderate party leadership and the conservatives. The former have been proposing a partial rollback of Obamacare, one which would, for example, lift the requirement to purchase coverage, but retain insurance eligibility for people with pre-existing conditions.

Conservatives, led by Ted Cruz of Texas, Mike Lee of Utah and Rand Paul of Kentucky, have derided this approach as “Obamacare Lite,” and say they will “accept nothing less than full repeal.”

The situation wasn’t much better after the president finished speaking. Republicans were as divided over the intent of the president’s speech as they have been over the definition of “repeal and replace.” The use of the phrase in his remarks did not settle the matter.

It was a comedy of opposite perceptions, each side claiming that the president had endorsed their program, not the others.’.

House Majority Leader Kevin McCarthy (R-Calif.) pronounced it an endorsement of the leadership’s plan. “He said there should be tax credits, he said states should have more flexibility, he says we’ve got to [deal] with Medicaid and the transition, so what’s the Republican plan?” McCarthy said. “He just laid it out.”

Rep. Mark Sanford (R-S.C.), an ally of Sen. Rand Paul on the issue, resisted that interpretation. “We all hear what we want to hear in life,” Sanford said of McCarthy’s comments. “What I heard Trump say was something very similar to what Sen. Paul and I introduced. The leader must be hearing something a little different.”

“I heard repeal and replace, which is what we all campaigned on,” said Rep. Jim Jordan (R-Ohio).

The more popular and humane provisions, like coverage for pre-existing conditions, have become entrenched in a mere seven years. Conservatives may rail at them as overnight entitlements, but they will be as hard to take away from the millions of Americans who need them as Social Security and Medicare. Even the more objectionable clauses have to be teased carefully out of the web of healthcare and the economy so as not to cause disruption and suffering.

President Trump recognized this fact in his address.

“We should ensure that Americans with pre-existing conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the healthcare exchanges,” the president declared.

Despite a Democratic majority, his predecessor in the White House did not get everything he wanted in the Affordable Care Act. The incumbent will not get everything he — or the conservatives — want in repealing and replacing that law, despite a Republican majority.

House Speaker Paul Ryan of Wisconsin saw unity on Tuesday night, despite it all:

“You’re going to have a lot of churning on any kind of legislative product like this,” Ryan said. “This is a plan that we are all working on together — the House, the Senate and the White House — so there aren’t rival plans.”

“I feel at the end of the day when we get everything done and right, we’re going to be unified,” Ryan said.

E Pluribus Unum