Gutting Obamacare in its entirety is not a viable solution for Republicans since some of the healthcare mandates provisions don’t impact the federal budget, a requirement for lawmakers to avoid the 60-vote filibuster in a parliamentary procedure known as reconciliation, according to Politico
To fall under the reconciliation umbrella, according to Politico, any Obamacare repeal — as Republicans have vowed — requires the deficit to be reduced, meaning the GOP would have to decide which parts of the law to scrap.
"The entire process has the makings of a difficult political exercise that will reveal something about the GOP’s priorities when it comes to the reviled law, forcing the party to go beyond the pile-on repeal rhetoric and say specifically what it would do and how it would pay for it," the website reports.
There are both political and legal hurdles to consider.
For example, should the GOP punt the mandates and taxes that are the law's stalwarts, "they’d have to plug a trillion-dollar hole. Cut the Medicaid expansion to the states? Sounds simple enough, but then they could put themselves at odds with governors."
If federal subsidies are yanked, the nearly trillion dollars in savings could be used to repeal other parts of the law, according to Politico, though the move is considered politically risky for moderates who could "experience a political backlash for slashing health care tax credits for poor and middle-class families."
Conversely, extending or replacing the subsidies could draw the ire of conservatives, because doing so would further limit their repeal options.
cites a policy brief published by the American Academy of Actuaries
that states Republicans' long-term replacement idea — allowing Americans to purchase health insurance across state lines — would amount to a "race-to-the-bottom in terms of plan quality" unless national regulations and standards are implemented.
Wisconsin Sen. Ron Johnson has proposed temporarily extending subsidies into 2017, an idea that the Academy of Actuaries finds would only be a short-term fix.
"Since the Republican plan is to temporarily extend the subsidies with the explicit purpose of 'replacing' Obamacare with ??? in two years, it’s just delaying the disaster," said Salon.com writer Jim Newell.
Republicans have some "wild card" solutions, such as taking into account assumed economic growth to help "plug the costs of repeal," according to Politico, or finding savings elsewhere to pay for the repeal similar to the Democrats' cutting education "to help pay for the overhaul in the first place."
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