This should be the moment President Donald Trump cleans up Obamacare with a broad smile on his happy face.
He won the Electoral College — and as his predecessor Barack Obama liked to say, "Elections have consequences." Trump's Republican Party controls the House and the Senate, which should mean there are no sand traps or water hazards on his golf course.
Problem is, Trump finds himself in the land where it's often easier to vote no than to vote yes. Members of his own political party and conservative think tanks became standouts because of their principled opposition to Obamacare. Now their party wants them to support a plan championed by House Speaker Paul Ryan that doesn't live up to their pre-2017 rhetoric.
The House plan keeps two popular provisions of the Affordable Care Act — adult children can stay on their parents' health plans up to age 26 and insurers can not deny coverage based on pre-existing conditions.
Ryan reconfigures other provisions. His House plan ends the individual mandate that required most adults to get coverage or pay a fine; instead it requires insurers to add a 30 percent surcharge for individuals who allowed their coverage to lapse. Some conservatives complain that the surcharge is a mandate by another name.
The House plan ends premium subsidies, but replaces them with tax credits for middle-income earners who buy their own coverage. That's a different form of entitlement spending, critics say.
Probably the hardest change politically is a switch to a formula that tells insurers they can't charge older consumers more than three times what they charge young adults. The House plan would allow health care providers to charge seniors up to five times what they charge 20-somethings — a change offset by higher tax credits for Americans aged 60 to 65. The new formula should make coverage more attractive to the youth market the system desperately needs.
The Affordable Care Act reimbursed 31 states that increased their Medicaid enrollment for families earning up to 138 percent of the poverty level. The House plan would continue the full federal subsidy until 2020, when the system would switch to block grants for states. Conservative critics want to end the full federal subsidies in 2018. Trump has signaled he is open to accommodating them.
The House plan would end Obamacare taxes on medical devices and so-called Cadillac health plans. The GOP plan also would end the employer mandate that the right sees as a job-killer.
Rachel Bovard of the Heritage Foundation summed up the opposition when she said, "If you ask the average American person what Obamacare really means, it means that the insurance plans that they used to have that they liked were canceled and replaced with plans that cost you know 20, 30, 50, 100 percent more than they used to." She doesn't see the Ryan plan delivering pre-Obamacare health care. The tax credits, she added, "will just give people money."
It especially angers the right that the Ryan plan rewards the 31 states that expanded their Medicaid rolls, rather than reward states that did not.
Bovard sees an easy remedy — let Congress pass the same repeal measure that both the Senate and House passed in 2015.
Bad idea, countered House Majority Leader Kevin McCarthy at a press conference Friday: "If you just repealed the bill, you would double your premiums and you would collapse the market."
McCarthy did not add that when Congress passed the repeal bill, Republicans knew that Obama would veto it. They had nothing to lose.
McCarthy stood with Committee chairmen Greg Walden of Energy and Commerce, Kevin Brady of Ways and Means and Diane Black who chairs the Budget Committee. These are the Republicans who have to do the heavy lifting — and they know that means not losing moderate Republicans who want low-income families to feel secure about their health care.
"Sometimes when you have pushback on one side and the other side from a political spectrum, you might have found the sweet spot," McCarthy argued.
At a Politico event Thursday, Senate Majority Leader Mitch McConnell suggested Republicans have to get out of their default position of "sparring" and get into "governing mode."
Sparring has become the domain of Democrats. During the Obama years, they were outraged at Republican obstructionism. Now they call their obstructionism "resistance" — without even a hint of irony.
Health giant Humana has announced it will exit the exchanges in 2018. Last month Aetna CEO Mark Bertolini told the Wall Street Journal that Obamacare has entered a "death spiral." Trump's election win has allowed the left to dodge the bullet it created.