Immediately after Inauguration Day, Republicans are planning to use their dominance in Washington to enact the most radical overhaul of spending and taxes in a half-century.
Soon after the new Congress convenes next month, they plan to repeal some of Obamacare, delighting the right-wing base. The critical element, replacement, would come later. In the more than six and a half years since the Affordable Care Act became law, Republicans have yet to find a consensus on replacement.
If they get a partial repeal, congressional Republicans might try to cobble together a replacement by the spring. This would be part of a huge bill that might include a big tax cut and major cuts in domestic spending programs, including turning the most important low-income assistance initiatives into block grants to the states, with eventual cutbacks. Look for a lot of fiscal gimmicks and sleight of hand.
House Speaker Paul Ryan and many conservative Republicans also would like to partially privatize Medicare, which could result in major budget savings down the road. The best bet now is that Trump, who vowed during the campaign that there would be no cutbacks to Medicare, will balk and the Republicans will blink.
Overall, says Robert Greenstein, president of the liberal Center on Budget and Policy Priorities research group, these plans “pose the greatest threat to the social safety net since it was created.”
The initial repeal will go through a special budget process called reconciliation, which would eliminate the Obamacare mandates and retain, for a while, the more popular provisions. If it follows earlier Republican measures, it would repeal the small Obamacare tax hikes on upper incomes, while cutting provider reimbursements for hospitals. The promise would be to do replacement later.
Expect Democrats to soon voice the mantra: No Repeal without Replace. It may bring political pressure on the Republican plans, as the uncertainty caused by promises that re vague and very difficult to achieve could wreak havoc.
If the plan is successful, things will get interesting. Republicans envision a second reconciliation, under the same rules.
SOURCE: Albert R. Hunt