The Sum of Its Parts

We're just two weeks away from the start of open enrollment for the new state health care exchanges established as part of the Affordable Care Act, and it's safe to say that Republicans will not be able to repeal the law between now and then. It's equally safe to say that they won't be able to repeal it by January 1, which is when the people who sign up for insurance through those exchanges start on their new plans. That's also the date when a whole bunch of other components of the law take effect. When that day comes, will Republicans have to abandon all hope of ever repealing it?

The ones who don't understand the law (and let's be honest, that's probably most of them) might answer yes. Once it goes into effect and begins destroying lives, sapping us of our precious bodily fluids, and generally turning America into a socialist hellhole where all hope has died and the flickering flame of freedom has been snuffed out, people will quickly realize what a disaster it is and support repeal. The problem is that come January, the ACA will be transformed. It will no longer be a big, abstract entity that would be possible to undo. Instead, it will be what it truly was all along: a large number of specific reforms and regulations that in practical terms are entirely separate from one another. What this means is that once it takes effect, "Obamacare" for all intents and purposes will cease to exist.

There's a reason that when the cretins at FreedomWorks wanted to encourage people to burn their Obamacare cards, the first thing they had to do was print up fictional Obamacare cards so people could burn them. Unlike an insurance program like Medicare or Medicaid, Obamacare is a diffuse series of regulations affecting both existing government programs like those but also private insurance. No one will ever say, "Don't take my Obamacare away," because they won't have a thing called Obamacare, even if they're benefiting from it. That's a political problem for Democrats, but it's also a practical problem for would-be repealers. Because once it goes into effect, repealing it would be enormously complex. For instance, one of the main components of Obamacare is an expansion of Medicaid. If you repealed it six months from now, would people who are newly enrolled in Medicaid get kicked off? And what if you got private insurance through an exchange? Would you have your policy cancelled? The law eliminated annual and lifetime caps on coverage—would those return, or still be restricted in some way? For low- and middle-income people who got subsidies to buy insurance, would they have to give the money back, or would they keep it for that year? What about the small businesses getting subsidies to give insurance to their employees?

So repealing Obamacare after implementation wouldn't just be politically difficult. Undoing it would require writing a whole bunch of complex new rules to unwind the regulations. And the last thing Republicans want to do is spend a bunch of time figuring out the details of health reform, or in this case, health un-reform.

Once it's fully operating, Obamacare becomes nothing more than the sum of its parts. Sure, you could pick out one of the less popular pieces and repeal it, but then you wouldn't be "repealing Obamacare." That isn't to say Republicans won't continue to rail at it, and hold some more silly repeal votes in the House (because sure, they've voted to repeal it 40 times, but has America gotten the message?). But as a practical goal, repeal will be even more impractical than it is now. And then what are they going to do?

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