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Tuesday, March 25, 2014

GOP finds unwinding Obamacare vexing now that it's taken root -- By Byron York, The Washington Examiner

Even if Obamacare can be repealed, the path to replacing it will be even more difficult now that the law is mostly in effect. (Thinkstock)Republicans are still determined to repeal Obamacare, even though they have famously failed to unite behind an alternative. Now, it is dawning on some in the GOP that even if they succeed in repealing the Affordable Care Act, and even if they pass an alternative, they will still have to come up with a plan to get from here to there. Right now, they don't have one.

What is different about Republican calls for repeal today -- as opposed to calls for repeal from 2010 to the end of 2013 -- is that Obamacare is now in place. It exists. Exchanges are running -- many of them badly, but running. subsidies are being paid. Insurance companies have changed the way they do business. Medicaid has been expanded. Special taxes are being collected.

Even though the system is new, millions of Americans have gone to a lot of trouble to adjust to it, and it would be disruptive to them to just stop cold. Halt subsidies? Undo Medicaid expansion? Just as last fall, when millions of Americans received coverage cancellation notices, millions more would face new burdens under the repeal of Obamacare.

"Rolling key provisions of the Affordable Care Act back would only create a new set of offended parties who would want to keep the insurance they have," health care analyst Robert Laszewski wrote recently. "Have you heard the one about, 'If you like your health insurance, you can keep it'?"
Republican plans are not designed to throw people onto the streets. But they will be different from Obamacare, and people will have to be covered in some way. And that will involve far-reaching changes in a system that people are still trying to understand.

"I have not seen very much in the way of discussion about a post-Obamacare transition," says one House Republican. "It's a good point, though -- repealing Obamacare doesn't bring us the health insurance market as it existed in 2009 [which would have been easier to reform] but leaves us with the system as changed by Obamacare."

The Republican notes that it's difficult to say precisely how the Affordable Care Act will work in the future because President Obama has unilaterally changed so many parts of it. For now, the Republican adds, the House GOP has focused mostly on general reform principles, although "at some point we will need to be able to explain to people how this will work in practice."

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