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Thursday, August 17, 2017

This article originally appeared in USA Today.

When it comes to repealing and replacing Obamacare, many have compared the GOP to the dog that caught the car, or the ambulance.

Republicans know better than anyone that Democrats paid a steep price for insuring millions of people. Now, after televised scenes of furious Americans rallying against repeal even before the new president took office, they’re beginning to see that uninsuring millions won’t be as much fun as slamming snout first into a bumper at full speed.

“We’re going to have insurance for everybody,” Donald Trump told The Washington Post a few days before he was sworn in.

You can bet no one has any idea what that actually means. That includes Rep. Tom Price (R-GA), Trump’s nominee for secretary of health and human services, who dodged details at a confirmation hearing on Tuesday. It also includes Trump, who has yet to demonstrate that he actually knows what’s in the Affordable Care Act, let alone how he would replace it.

Health care reform isn’t a branding problem you can tweet away with strategic misspellings, huge empty promises of “something terrific,” or even a meeting with Family Feud’s Steve Harvey.

Health insurance isn’t a wall you can pretend to build.

You don’t need a fact-checker to tell you that you’ve been uninsured. And there will be no President Obama around to blame when Trump voters can’t pay medical bills because an insurance market Republicans have promised to fix suddenly begins to crumble.

Here’s what Republicans won’t tell you about the mess they’ve gotten us all into:

1. If they go through with any substantive repeal of the Affordable Care Act, they probably won’t be able to replace it — ever.

If you want to cover “everybody,” you either have to establish some meaningless standard for coverage that evaporates any time you have an ailment bigger than half a hangnail, or you have to spend money — even more than the billions of dollars Republicans are eager to give back to the richest Americans. “If you end it in three years without a replacement, what Republican is going to vote for a tax increase to fund it?” asked Senator Bob Corker (R-TN). “I don’t know any.”

2. Repeal isn’t inevitable.

“Right after the election, Republicans vowed to have a repeal bill on Trump’s desk on January 20,” Topher Spiro, vice president for health policy at the Center for American Progress, told me. “That timeline has already slipped, and is slipping even more as we speak.” Senate Republicans have shown they have the simple majority they need for repeal, but about a half dozen of their 52 members have expressed concerns about repealing Obamacare without a decent replacement. That’s more than enough to create uncertainty.

3. If Trump has an actual plan to cover everybody, Republicans would be his problem.

“Most fundamentally, [Republicans] have no idea how to keep their promise to cover as many people as the Affordable Care Act,” Spiro explained. “That’s because it’s a false promise: Expanding and maintaining coverage is not, and has never been, their goal. But they just can’t seem to come out and admit that they don’t care if people lose coverage.” Trump told The Washington Post, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it.” The “circles” he’s referring to are better known as “The Republican Party.”

4. Repeal could weaken everyone’s insurance.

Obamacare removed both yearly and lifetime caps on insurance, something you only probably noticed if you or a family member has had a serious illness. As Spiro notes, it also expanded free coverage of preventive services like colon cancer screening, mammograms, and flu shots. And it put a limit on what insurance companies can charge for out-of-pocket costs. All of that affects even those who get insurance at work.

5. If a replacement plan did pass, it would leave Republicans open to the fiercest attack they made on the ACA.

Having no ability to repeal the law gave Republicans the freedom to attack Obamcare for offering their favorite kind of insurance — high-deductible plans that force consumers to think about price as they make medical decisions. GOP proposals “offer threadbare, catastrophic coverage with enormous deductibles,” New York magazine’s Jonathan Chait wrote. “The English vernacular term for the kind of insurance Republican health care plans would offer is ‘crappy.’ ”

Trump promised us “something terrific.” He just didn’t explain it was a terrific mess that could end with Americans finally discovering how much they had gained, right as he takes it away.

IMAGE: House Speaker Paul Ryan hands the pen to Rep. Tom Price, Trump’s HHS nominee, after signing a bill repealing Obamacare at the U.S. Capitol in Washington, January 7, 2016. REUTERS/Jonathan Ernst

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