Juan Williams: Republicans face up to reality on ObamaCare

Thanks to Donald Trump’s stunning win, the Republican majorities in the House and Senate now have hands in the White House capable of bringing the guillotine down on ObamaCare.

And doing so is at the top of the Republican domestic agenda.

So, why does the GOP executioner suddenly look so hesitant?

{mosads}The reality is that Republicans on Capitol Hill and the Trump team see that their own heads could roll.

Republican voters, having been told that ObamaCare is a disaster, expect quick action. They wonder how hard is it to throw dirt on the grave and accept the cheers of a grateful nation.

The problem for the GOP executioner in Washington is that, once the deed is done, Trump will have to take responsibility for creating a better plan for American healthcare — especially for the more than 20 million people who will lose health insurance once ObamaCare is buried.

President-elect Trump put the potentially explosive political problem in simple terms earlier this year during the primaries: “We do need healthcare for all people. What are we going to do, let people die in the street?” 

Later, as the party’s nominee, Trump was forced to get into line with GOP orthodoxy by just promising to kill off ObamaCare.

But Trump’s instincts were right when he pointed to the millions that will be left without insurance if the Affordable Care Act (ACA) is repealed.

And then there is the added cost to the healthcare system if ObamaCare dies.

The RAND Corp. estimates the death of ObamaCare will add $6 billion to the deficit in the first year it is gone. The Committee for a Responsible Federal Budget puts the price of losing ObamaCare at $550 billion in the next decade.

And the demand for ObamaCare remains lively despite the constant attacks from the GOP.

This month, more than 1 million people signed up for the healthcare program, exceeding the number that signed up last year during the same timespan. After Trump’s victory, people signed up at an even faster rate.

Already President-elect Trump, in an interview with The Wall Street Journal after the big win, has started hedging. He said he wants to keep alive some popular elements of ObamaCare.

But how can the new president cherry pick parts of the plan for reprieve if he kills its central funding mechanism, the individual mandate for all Americans to buy insurance? The individual mandate keeps the most popular parts of the law alive. 

Meanwhile on Capitol Hill, Speaker Paul Ryan (R-Wis.) is busy trying to prevent explosive political fallout from killing ObamaCare by promising that its death will protect Medicare.

In a Fox News interview two days after the election, the Speaker tied the two programs together by arguing that “because of ObamaCare, Medicare is going broke.”

The political blowback against Ryan was hot. FactCheck.org soon wrote that Obamacare “actually improved Medicare’s financing, and [Medicare] isn’t going broke.”

The Speaker has long advocated ending Medicare as an entitlement for the elderly and replacing it with vouchers of limited value. That will keep a lid on Medicare costs. Elderly Americans, however, would lose the guarantee of government-paid healthcare for all their ills. Grandma sees the cliff approaching fast.

Ryan’s big stumble also increased demand for details of Republican plans to replace ObamaCare. 

Despite six years and more than 50 votes to repeal ObamaCare, the only alternatives offered by the GOP don’t help the poor because they center on private healthcare accounts and tax deductions for healthcare costs.

There are no new ideas for how to deal with the financial strain attached to having insurance companies cover people with pre-existing conditions or allowing young people to stay on their parents’ plans.

A Washington Post editorial in July ridiculed the House GOP plan — titled “A Better Way to Fix Health Care,” — as “difficult to evaluate or take seriously,” because it lacked a funding plan and looked to “be hard on the poor, old and sick.” 

“This many years on, the GOP has no excuses for blank spaces,” The Post concluded. 

Rudy Giuliani, the former mayor of New York City and a senior adviser to the president-elect, said last week that the recent notifications about increases in health care premiums was a bigger factor in Trump’s victory than were FBI Director Jim Comey’s actions regarding Hillary Clinton’s e-mails. 

“I think ObamaCare was the bigger hit, the fact that those premiums hit on… November 1,” Giuliani told ABC.

What are the people who voted against ObamaCare to think when they now hear insurance company executives say they don’t know of any credible Republican plan to deal with uninsured Americans?

What do they think when the GOP offers nothing to equal the ACA’s success in restraining the rising cost of health care, including the cost of healthcare provided by private employers? 

“We started with a fresh piece of paper yesterday — we had no idea how to approach it,” Mark T. Bertolini, the CEO of Aetna, told Andrew Ross Sorkin of the New York Times the day after the election. 

Referring to the millions who will lose their health insurance, Mr. Bertolini said, “You can’t put them out on the street without insurance.”

That sounds a lot like what Trump was saying earlier this year. 

No wonder Republicans now fear that killing Obamacare may cost them their political lives.

Juan Williams is an author, and a political analyst for Fox News Channel.