2014 will be the year Republicans are forced to deal with the Obamacare Trap, helpfully set for them by the Democratic authors of the Affordable Care Act.
In 2009 and 2010, President Obama and his party took a health care system in which 85 percent had insurance coverage, and blew it up. Now, with Obamacare causing misery right and left, those same Democrats are screaming, "You can't go back!"
The national health care scheme they designed is so complex and has already embedded itself so deeply in the health care system, they argue, that it can never be repealed. The only course now is for lawmakers of both parties to "fix" Obamacare's problems.
The argument will be heard more and more as the burdens imposed by Obamacare — cancelled policies, higher premiums, higher deductibles, narrower doctor networks, restricted choices of prescription drugs and more — become a reality for millions of Americans. The situation could become even more politically charged if, as many experts expect, the burdens that have so far beset those in the individual insurance market spread to the small-group market and ultimately to the larger universe of all people who receive coverage through their jobs.
In such a scenario, Democrats will ratchet up their demands that Republicans join them in "fixing" the law. They will condemn Republicans who declare Obamacare beyond repair and decline to go along. And at the same time, Democrats will steadfastly refuse to back down in their full support of the law they — and they alone — passed that is causing all the trouble. The blame, they will argue, lies with the GOP.
It's an astonishingly brazen strategy. And it might work.
Already, some Republicans appear to be wavering on the insistence that repeal must be the first step in minimizing the damage done by Obamacare. In a weird irony, the more serious the problems of Obamacare become, the less likely some Republicans are to demand repeal.
"It's so bad that you just can't let it happen," says one well-connected GOP strategist. "My sense is, at least at this point, it's gotten so bad that as much as you don't want to fix Obamacare, you just can't let the impact of this happen."
Says a House Republican aide: "Measures that provide Americans some form of relief from the most painful parts of Obamacare don't have to begin with repeal."
Of course, many ways Republicans would want to provide Obamacare relief — Rep. Fred Upton's keep-your-health-plan proposal, for example — won't win Democratic support. But the more fixes the GOP signs on to, the more incentive Democrats have to keep stonewalling all calls for repeal.
Other House Republicans are (finally) uniting behind an actual repeal-and-replace proposal. H.R. 3121 is the work of the Republican Study Committee, and, like another effort by GOP Rep. Tom Price, would both repeal Obamacare and enact a package of Republican health care reforms. It would address the tax unfairness of purchasing health coverage for those who are not covered at work; the problem of pre-existing conditions; the purchase of coverage across state lines and excessive medical malpractice settlements.
So far, 117 House Republicans have signed onto the bill. But 115, including the House GOP leadership, have not. And it is not clear whether passing an Obamacare alternative — one that begins with repeal — is really a priority for Speaker John Boehner and other top House Republicans.
For example, on "Meet the Press" Sunday, House Budget Committee Chairman Paul Ryan expressed satisfaction with the recent budget deal because Republicans "don't want to have shutdown drama so that we can focus on replacing Obamacare." That sounds like Ryan wants to pass an alternative. But while Ryan encourages Republicans to come up with "conservative solutions," there's no evidence he wants to throw his weight behind any one bill.
In fact, in private discussions, House Republicans stress their differences over the details of an Obamacare alternative. For example, there's no agreement on precisely how to fix the tax inequity for people who don't receive health coverage at work. There are similar disagreements over all sorts of other points of policy. "Getting unanimity is a tall order for a divided, leaderless party," says the GOP aide.
Meanwhile, Obamacare threatens to turn into an enormous, rolling disaster. While Americans suffer, Republicans could find themselves arguing with each other, hung up on details, divided over the next step and under pressure to endorse Democratic fixes to a law they never supported — in other words, deep inside the Obamacare Trap.