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Why the GOP is getting worried about its plan to kill Obamacare

Nancy Pelosi, Chuck Schumer, Bernie Sanders, and about a dozen other Democrats stood together on Wednesday to announce their plan to defend Obamacare from Republican repeal — the most unified and aggressive show of force since their party's original push for the law seven years ago and more so than in any election since.

"We are united in our opposition to these Republican attempts to Make America Sick Again," Schumer said, cracking a slight smile at the inversion of Donald Trump's campaign slogan.

The line suggests that Schumer wants to reframe the fight over Obamacare into one about the broader GOP health care agenda, which includes proposals to change Medicaid and Medicare.

Since the health care law passed in 2009, Schumer and other Democrats in Congress have learned that defending it can be a political loser. Republicans stayed unified in their opposition, and public opinion stayed on their side. But in their final push to save it, Democrats are moving the battle to new turf, fighting over Americans' shared frustration with the inadequacies of the country's health care system, not the law itself.

Meanwhile, Republicans are on new ground themselves, divided for the first time since the law was passed. They aren't sure whether to repeal now and decide later what program should take its place or even what replacement plan might come next.

This new dynamic — Democrats unified and Republicans at odds — makes it an open question what the future of Obamacare will look like, even as Republicans prepare to control both the Congress and the White House.

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Democrats want to mix Obamacare repeal with Medicare privatization

The cardboard sign at the Democrats' Wednesday press conference set the tone: "The REPUBLICAN plan to cut Medicare, Medicaid, & the ACA" will "MAKE AMERICA SICK AGAIN."

Schumer mixed and mashed the separate Republican attacks on Obamacare and Medicare, often blending the two together in the same sentence.

"Republicans are executing and will soon launch a full-scare assault on the three pillars that support the American health care system: the Affordable Care Act, Medicare, and Medicaid," Schumer said. "Republicans should stop clowning around with Americans' Medicare, Medicaid, and health care."

Schumer's attack combines a number of different Republican proposals, some more likely or more imminent to make it before Congress than others.

Republicans huddled on Capitol Hill this week to discuss their plans to gut Obamacare — that's the big question out of the gate in the new Congress. Schumer's Medicaid and Medicare references point to plans that House Speaker Paul Ryan has outlined but that aren't up for an immediate vote. (Trump has appointed Georgia Rep. Tom Price — who shares many of the speaker's plans for Medicare — to head the Health and Human Services Department.)

But these distinctions are not a subtlety Schumer has an interest in fleshing out at a press conference. It makes much more sense for him to knock Republicans for their desire to radically change the popular pillars of America's health care while simultaneously going after them for targeting its least popular elements — a move that also has the upside of being true.

The Republican crack-up on Obamacare

Meanwhile, Republican senators are uneasy about what their plan should be.

Kentucky Sen. Rand Paul said on MSNBC Wednesday that he wants the conference to repeal and replace Obamacare all at once, not kick replacement down the line. He argues that doing one without the other will send the insurance industry into a spiral.

Other Republicans fear they're simply going too far. Speaking on the condition of anonymity, a Republican senator told Bloomberg today that his caucus is increasingly terrified that their Obamacare repeal package goes too far. And at a closed-door meeting, another worried about the "consequences" of repeal and urged Republicans to tread cautiously, according to Talking Points Memo.

Vice President-elect Mike Pence visited Capitol Hill on Wednesday to talk about Obamacare, but it's not entirely clear what Trump's appetite is for changes to the health care system. Trump has only really embraced one part of the Republican Congress's health care reform agenda: Obamacare repeal. As Democrats like to point out, and as Sanders reiterated on Wednesday, Trump was adamant during the presidential campaign that neither Medicare nor Social Security was on the table for cuts.

Schumer's political calculus in "Make America Sick Again" was to collapse the contradictions in Trump's position. If you could make the public believe that reasonably popular Obamacare repeal was tied to fiercely unpopular Medicare privatization, then the appetite for cutting the former would be greatly diminished.

Trump himself appears to recognize the danger here. In a series of tweets Wednesday morning, Trump tried to isolate Obamacare as a unique cancer on American health care that Republicans would have to try to fight.

The bipartisan turn on the national health care debate

For weeks, pundits have puzzled over what appears to be an agonizing choice for Democrats on Capitol Hill. If they work with congressional Republicans on an Obamacare replacement package, they'll give the GOP legislation bipartisan cover — and Trump an early political victory.

Democrats could instead refuse to work with Republicans on health care reform and an Obamacare replacement. But while that would give them room to attack whatever Republicans push through, it would also ensure that they have no impact on legislation that could deprive millions of their health care — legislation the GOP can pass without any Democratic votes anyway.

Schumer has rejected this apparent dilemma as a false choice. Instead, he argued that Democrats have an obvious path forward — stand clearly against all of the GOP's health care plans until there's any sign Republicans are interested in doing anything acceptable to Democrats.

So far, nothing of the sort has materialized. And as long as it doesn't, Democrats will be free to make the case that Republicans own all of the negative press that arises about any Obamacare repeal push.

"They're now responsible for the entire health care system; all the problems in the health care system are going to be on their back," Schumer said of Republicans on Wednesday.

Commentary by Jeff Stein, a writer at Vox.com.

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