The emerging “repeal and delay” strategy, which Speaker Paul Ryan discussed last week with Vice President-elect Mike Pence, underscores a growing recognition that replacing the health care law will be technically complicated and could be politically explosive, says The New York Times.
Under the plan discussed last week, repeal will be on a fast track. Republicans hope to move forward in January or February with a budget blueprint using so-called reconciliation instructions, which would allow parts of the health care law to be dismembered with a simple majority vote, denying Senate Democrats the chance to filibuster.
Since the law was signed by President Obama in 2010, 20 million uninsured people have gotten coverage. The law has become deeply embedded in the U.S. health care system, accepted with varying degrees of enthusiasm by consumers, doctors, hospitals, insurance companies and state and local governments.
Unwinding it could be as difficult for Republicans as it was for Democrats to pass it in the first place and could lead the GOP into a situation where the existing law was in shambles but no replacement could pass the narrowly divided Senate. Democrats would face political pressure in that case.
“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” says Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”
"It is not sheer coincidence that at least one idea envisions putting the effective date well beyond the midterm congressional elections in 2018,” says the Times.