Obamacare reform

As for overhauling the overhauled U.S. health-care system, President Donald Trump gives conflicting signals.

When House Republicans did their dance earlier this year with this complicated issue, Trump did a high-five at the White House with the authors and backers of the GOP health-care plan. Later, he privately pronounced some of the House plan’s cuts to the Affordable Care Act, more commonly known as Obamacare, as “mean,” and expected the Senate to fix the problem.

With Senate Republicans, however, unable to agree on what to do, the president is now saying he is open to the idea, floated by the Senate’s most conservative members, to repeal Obamacare first and worry later with enacting its replacement.

That would be a terrible idea, further unsettling insurance markets, which don’t like uncertainty. It’s also not what the president promised repeatedly on the campaign trail last year. Nor is it what Republicans have been promising almost from the day Obamacare was enacted, over their opposition, seven years ago.

Trump and congressional Republicans said — over and over and over again — that if the American people just gave them control of both Congress and the White House, they would repeal Obamacare and replace it with something much better.

 Dozens of times while he was gaining ground and eventually overtaking Democratic nominee Hillary Clinton, Trump promised to “repeal and replace” Obamacare in the early days of his administration.

Typical was this comment he made a week before his election victory: “When we win on November 8th and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare — have to do it,” said Trump, adding, “Obamacare has to be replaced, and we will do it and we will do it very, very quickly.”

Not only has it not happened quickly, but it now appears that the president is leaning toward fulfilling only half of his promise.

Repealing Obamacare is not the big hurdle. With a Republican president and Republican Congress, that can be done in a snap. The real difficulty is what replacement wouldn’t be even worse.

What the Republicans have come up with so far can’t even find consensus within their own party. Moderates within the GOP are opposed to cutting off more than 20 million of the Obamacare-insured and scaling back Medicaid, the state-federal program that provides coverage for the poor, the disabled and the elderly. The party’s ultraconservatives say the plans don’t go far enough in restraining government spending.

If that impasse can’t be resolved now, why should anyone think it will be resolved a year or two from now?

The only way, given the current makeup of Congress, to effectively “repeal and replace” Obamacare is to pick up some Democratic votes to offset the GOP’s own dissenters to the right. That means fashioning a bill with which a majority of Republicans and at least a handful of moderate Democrats can live.

One of the things that has poisoned Obamacare is that it was enacted with zero Republican support. If Congress can come up with something that is at least moderately bipartisan, it might actually be a decent bill.

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