After Republicans pow-wowed on Obamacare on Wednesday, Vice President-elect Mike Pence came out vowing to repeal the law. Meanwhile Senate minority leader Chuck Schumer, after huddling with President Obama and other Democrats, insisted the GOP has no replacement and that repeal will lead to "chaos."
But while this is starting out looking like another nasty D.C. gridlock fight, don't be surprised if we actually get a deal.
Sure, this is starting out looking pretty ugly. The outgoing president is trying to figure out how to save the Affordable Care Act or salvage as much of it as possible, as the incoming president is warning Republicans in tweets to be careful not to drag their feet and allow the status quo to continue.
And the status quo is a mess. Despite all kinds of promises from both sides, Democrats and Republicans in Washington have never really gone to the bargaining table on Obamacare. That's a disgrace because this is a law that affects all of us in the most intimate of ways. Instead of coming to a compromise deal that most of American voters would accept, President Obama and the Democrats used their super majority in Congress from 2009-2011 to enact the existing ACA. And when the Republicans took control of the House in 2011 and the whole of Congress in 2015, all we saw from their side was repeal vote after repeal vote.
But now that a much less ideological President-elect Trump is coming to the White House, there's a chance of some real deal making in the near future. It sure seems like Trump wants to pass something real to replace Obamacare or else his party will own all the bad news and bad health care cost realities to come.
And it's going to take negotiation with Democrats to make it happen. The question is: What kind of health care bill or policies will Congressional Republicans and Democrats agree on that President Trump will still support? The best way to arrive at the answer is to look at a few of the existing provisions in the ACA that have the best chance of surviving and those with the shortest expected lifespan.
The first deal that seems most likely to happen, IF everyone is willing to sit down and negotiate, is nixing the coming so-called "Cadillac Tax." That tax is a 40 percent levy on what employers and workers jointly pay for an employee's health coverage above a certain threshold — $10,200 for individual coverage and $27,500 for family coverage. The problem is, the plan is supremely unpopular for unions because high-end health-care benefits are among the most valued parts of negotiated labor contracts.
Given the Democrats' need for support from union leadership, Trump's impressive rank-and-file union voter support, and Republican opposition to the tax because most CEOs hate it too, and you could say the Cadillac Tax has about the same life expectancy as one of those red-shirted extras on "Star Trek."
Second, Trump has long been a supporter of the traditional Republican argument that the cost of health coverage will at least be forced down a bit by allowing insurance companies to compete across state lines. The funny thing is that most big insurers have thrown cold water on this notion for a long time. But given the extra work they would have to do to compete in a truly national market, it's hard to take their word for it.