The Affordable Care Act (ACA), like it or not, is a law that has provided health care coverage for millions of American people.
Our problems with it are many and varied and often have been enumerated in this space, but the portion of it authorizing coverage remains in place.
President Donald Trump and the Republican Congress, in an effort to provide less expensive, less burdensome and more effective health care coverage, offered several alternatives to the ACA in the spring and summer of 2017 that weren't approved. Now that the Mueller investigation is largely behind him, Trump wants to try again.
Perhaps it's a matter of always wanting to control the agenda or perhaps it's the idea of truly wanting something better for Americans, but we believe this is the wrong battle at the wrong time.
The Democratic House, burned because it thought it was that close - hold your fingers an eighth of an inch apart - to taking down Trump with the special counsel's report, is not about to work with him on replacing former President Barack Obama's singular piece of legislation. If you thought Democrats were oppositional when they were the minority party in the lower house, imagine how they'll be post-Mueller.
Republicans, having seen their ACA replacement efforts distorted and lied about in the national media and by their Democratic colleagues two years ago, aren't anxious to take the lead this time. For one, they know an appeals court is now considering a district court ruling in December that the ACA is unconstitutional since it no longer has an individual mandate. For another, they realize they may have lost some suburban House votes in the 2018 election over their opposition to some health care proposals in the ACA.
They'd also as soon have Democrats hang themselves with their Medicare for All proposals, and the Democrats are doing a good job of it so far. None of them can explain to anyone's satisfaction how the country could afford the proposal's estimated $32 trillion price tag over 10 years. None of them have a good answer about what happens when you put an entire industry out of business, either.
The president should let such a proposal continue to develop an odor, too.
So the GOP, if its members believe Trump really wants to give health care another whirl, are going to let the White House drive. The party's chief policymaker, Sen. Roy Blount, R-Missouri, said Republicans had no plans for an alternative at the moment and had had no discussions on the issue.
"We'll be eager to see the president's proposal," he said.
On Wednesday, House Majority Leader Sen. Mitch McConnell, R-Kentucky, kept the focus on Medicare for All proposals instead.
"Democrats are pushing a 'Medicare for None' scheme that would make it unlawful to provide the private health insurance policies that American families rely on and force everyone into a brand new government scheme designed here in D.C.," he said on the Senate floor.
Indeed, the topic of any Republican health care plans was not even brought up when Trump joined GOP senators for their weekly conference lunch earlier this week.
The problem is, if the appeals court strikes down the ACA (and pending a likely appeal to the U.S. Supreme Court), a substitution will be necessary or millions of people will lose their health care coverage. Democrats will rightly say the GOP should have been careful what they wished for, because that is in fact what the party has wished for - with many good reasons - since the bill was signed in 2010.
Perhaps that is Trumps's motivation. He wants something in place in case the law is invalidated.
Whatever the reason he wants to jump back into health care with both feet, he'll undoubtedly be reminded of the numerous campaign promises he made on the subject. They mostly center on the fact insurance would be available for everyone, people will be no worse off than they were under the ACA and no one who has insurance coverage will lose it. He also said there would be no Medicare cuts and supported not cutting off the insurance of people with pre-existing conditions.
Many Americans would welcome a new plan, but they also like to see promises kept. The promises Obama made about the ACA were not kept. If the Trump team creates a plan available to all those who can't get private insurance, that it leaves people no worse off than they are under the ACA, that it doesn't cut Medicare, that it covers pre-existing conditions and that it allows children to stay on their parents' plan at least through college, most people will be happy.
But that's a heavy lift when Democrats won't participate, when any failure is a potential 2020 election coffin nail, and when Medicare for All is such a convenient target.
Our advice would be to re-take the House next year and try to create a new plan in a potential second Trump term. But the president's never been good at taking advice. Controlling the agenda is more his style. We'll have to see how that works out.