For years, Republicans have promised to repeal the Affordable Care Act, the law better known as Obamacare.
After the election of Donald Trump, Republicans finally have the chance to do just that. Trump, House Speaker Paul Ryan, Senate Majority Leader Mitch McConnell, and a boatload of Republican lawmakers all pledged that a repeal and replacement of Obamacare was on the horizon.
Recently, however, there seems to have been a tonal shift in the way GOP lawmakers are addressing their approach to the law. Instead of leaning on the “repeal and replace” terminology, Republicans have begun to say they are “repairing” the ACA, a softening in their harsh rhetoric.
Repair, not repeal
“I think it is more accurate to say repair Obamacare because, for example, in the reconciliation procedure that we have in the Senate, we can’t repeal all of Obamacare,” said Sen. Lamar Alexander, head of the Senate Health committee last week.
Sen. Orrin Hatch, head of the Senate Finance Committee, told CNN that the GOP wants to “try and repair the law.”
Additionally, an increasing number of House Republicans have shifted to the “repair” terminology when referring to the Obamacare issue.
Here may also be a source for the change. Bloomberg reported that conservative pollster Frank Luntz told Republicans at a summit in Philadelphia that the “repair” language was more amenable to Americans and to use it instead of “repeal and replace.”
Ryan told Fox News, however, that repair does mean repeal and replace.
“To repair [the] American health care system, you have to repeal and replace this law, and that’s what we’re doing,” said in an interview with Fox & Friends.
Despite the protests of Ryan and whether or not the end result is different, it does appear that there has been a shift in rhetoric from GOP lawmakers.
A changing timeline
Not only have Republicans changed the way they talk about the law, but the timeline for the repeal or repair is slowly sliding further into the future as well.
Initially, indications from the GOP were that the repeal would come swiftly. Ryan and McConnell both wanted to get the repeal done within the first 100 days and a replacement soon after.
This timeline began to be extended, with Ryan and McConnell shifting the goal posts back to 200 days and seeming to leave the door open for the possibility of a repeal happening even later.
Trump, for his part, was adamant about swift action. During the transition, Trump said he wanted an Obamacare replacement done within weeks and derided a plan to pass a bill that would delay the repeal for a few years while the replacement was crafted.
In an interview on Sunday with Fox News’ Bill O’Reilly, however, Trump said that the Obamacare replacement was “in the process and maybe it will take till sometime into next year.”
There hasn’t been a consistent timeline set out by Republicans lawmakers, with the leadership still touting a quick process but other lower-level GOP members doubting the ability to make such a large change so swiftly.
Currently, the repeal process is ongoing, but the coherent and cohesive replacement plan has not been agreed upon by Republicans.
The reason behind the shift
There may be a number of reasons for the shift in tone and timing from Republicans.
One aspect is that many parts of Obamacare are still incredibly popular. Provisions such as the ability for children to stay on their parents until they turn 26 and the inability of insurers to deny coverage based on pre-existing conditions are popular with an overwhelming majority of Americans.
The broader law itself is also gaining in popularity with three recent polls showing more Americans in favour of the ACA than against it and record high approval in some polls.
Additionally, Democrats have frequently been touting the over 20 million people that have gained access to health coverage through the law. Concern over the possibility of large losses in coverage has hounded Republicans in recent weeks to the point Trump promised in an interview with ABC that the new plan would cover “everyone.”
Thus, the Republicans may be attempting to pivot the messaging away from a blatant repeal to a softer tone. While the plan has always been to replace the law, co-opting the popular parts into their message and pointing out the deficiencies at the same time seems to be a new part of their strategy.
The shift may also be an attempt to appease insurers, who are increasingly getting concerned about the viability of the individual health insurance markets. A large number of insurers said they may roll back their exposure to the individual market given the rhetoric from Republicans.
In the meantime, it appears that the Trump administration has done all it can to undercut the existing structure of the law. Data from the Centres for Medicare and Medicaid Services on Friday showed that enrollment for the federal exchanges through Healthcare.gov declined by 400,000 from the year before.
The drop came after a sharp fall-off in enrollment following Trump’s inauguration as the administration significantly decreased the amount of advertising and promotion of the exchanges. Prior to Trump’s inauguration, 800,000 Americans were enrolling per week, but that dropped to 200,000 per week post-inauguration.
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