Health Care Reform Not Dead Yet

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There is no doubt that the pathway to repealing and replacing Obamacare has been rockier than expected.

Yes, it is complicated.

Yes, it is politically difficult.

Yes, this has taken far longer than anyone expected.

So where are we now?

It appears that Senate Majority Leader Mitch McConnell, Kentucky Republican, next week will hold a procedural vote, known as a motion to proceed, to allow the U.S. Senate debate on health care to begin.

It is not clear whether the underlying bill will be the House repeal-and-replace bill or a clean repeal bill with an effective date that is two years away. I argued in December in my Washington Times column that an approach that sunsets Obamacare with a two-year phase-in would be the best approach.

By now we all know that Republicans have pledged to repeal and replace Obamacare for seven years.

That promise played a significant role in delivering massive Republican wins in 2010, 2014 and 2016, ultimately bringing Republicans unified control of the White House, the House and the Senate.

Republicans already have repealed Obamacare. They sent that bill to President Barack Obama, and he vetoed it.

Any Republican senator who now refuses to vote for repeal, after having voted to repeal it in the past, is holding an incoherent policy position of immeasurable cynicism. Obamacare has gotten worse since the last repeal vote. The reasons to repeal it have multiplied.

If you already have voted to repeal Obamacare, then you are susceptible to an attack for that vote. In fact, many members who faced tough races in 2014 and 2016 already have been attacked for that vote.

Whether the president of the United States will sign a bill is not a reason to vote for something. A bill deserves to be considered on its own, not based on what another co-equal branch of government will or won’t do in response to its passage.

Politics is the art of the possible.

Obamacare is unquestionably in a death spiral.

There are 1,300 counties in our country with one insurer or less, which is expected to hit 1,400 counties by year’s end. More than 80 insurers have left the Obamacare exchanges, which are spiraling out of control.

Eight million Americans paid a fine, totaling $3 billion, for not having health insurance in 2016. Should anyone be required to pay a fine for not buying a product?

President Trump is not giving up.

After two more Republican senators announced they would oppose the new Senate health care bill, Mr. Trump rightly expressed frustration, but he has not given up.

He convened a two-hour meeting at the White House, which included 49 Republican senators. Only Sens. Johnny Isakson of Georgia and Richard Burr of North Carolina chose not to attend. Sen. John McCain of Arizona is recovering from surgery and may return as early as next week.

During public comments in the meeting, Mr. Trump suggested that the Senate should remain in Washington until it passes a health care bill.

Mr. McConnell already has planned to scrap the first two weeks of the August recess, a deeply unpopular decision for members who have previously scheduled congressional delegation trips, vacations and meetings in their states.

A moment of clarity will arrive next week.

This opportunity to repeal Obamacare may never reappear.

Republican senators should vote yes to allow the health care bill to be considered, which then would allow amendments and a debate. If they cannot support the final bill, then they can vote no and be held accountable for that vote.

Senators cannot give up at the first sign of difficulty.

The House walked the plank and passed a repeal-and-replace bill, and that was not easy.

Most things worth doing are not easy.

As a senior administration official told me, voting no on the motion to proceed would “have the opposite effect of what they all have promised.”

Republicans were elected to repeal and replace Obamacare.

President Trump refuses to quit. The Senate cannot give up. Do your job.

Matt Mackowiak is the president of Austin, Texas, and Washington, D.C.-based Potomac Strategy Group, a Republican consultant, a Bush administration and Bush-Cheney re-election campaign veteran, and a former press secretary to two U.S. senators. His national politics podcast, “Mack on Politics,” is produced in partnership with The Washington Times. His podcast may be found on iTunes, Google Play, Stitcher and on the web at