When Political Imperatives Collide With Policy Objectives.

Abstract

T he Republican Party has been adamantly opposed to the Affordable Care Act (ACA) since it was signed into law in March 2010. The Republican House has repeatedly voted to repeal the ACA and after Republicans regained control of the Senate in 2014, the Senate voted to repeal it as well. However, Republicans in both houses of Congress passed such bills knowing that President Obama would veto them, as he did most recently in early 2016. Now that Republicans have control of the House of Representatives and the Senate as well as the White House, any legislation that passes Congress will presumably be signed into law by the Republican president. There is a “catch,” however. Republicans hold only a 52-48 lead in the Senate. This slim majority means that the Republican leadership needs 50 of its 52 members to support whatever legislation is being proposed and even then can only be assured of passing legislation that can be considered through the budget reconciliation process, meaning that it affects the budget or government spending. Budget-related bills can be passed with a simple majority and cannot be filibustered. Any other legislation requires the votes of 60 supporting Senators in order to overcome a filibuster, which given the 52 Republicans in the Senate, translates into bipartisan support. The challenge for Republicans is that having promised to “repeal Obamacare” as often as they have, it will be difficult to wait until they are ready with a replacement bill in order to “repeal and replace.” If the GOP caucus feels obligated to pass a bill that just effectively defunds the ACA, as did the bill passed by Republicans in late 2015, they could do that within the first two months of the new administration. The 2015 bill would have repealed the funding for the exchange subsidy tax credits, the funding for the Medicaid expansion, the individual and employer mandates, and the various taxes that fund the ACA, including