As Obamacare Grows, Repeal/Reform Republicans Become The Threat To Existing Healthcare

A dinosaur so soon.

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Sen. Ron Johnson, a tea party Republican from Wisconsin, knows that the politics of Obamacare are changing.

"It's no longer just a piece of paper that you can repeal and it goes away," he told the New York Times. "There's something there. We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare."

January 1st isn't likely to be a glitch-free day for Obamacare. There will be people who try and use their insurance and find they can't, or it's not the plan they meant to buy, or it's not a plan that covers their doctor. But those problems will, eventually, be solved. And their wake will be a game-changing reality: At least two million people will have health insurance through Obamacare's exchanges and more than four million people will have health insurance through the law's Medicaid expansion.

The GOP's campaign against Obamacare has been most effective when Republicans could claim, reasonably or not, that the law was taking something away from people: Canceling their plans, or penalizing them for going without insurance, or changing their doctor. But by the end of March, it's likely that at least 8-10 million people will be getting insurance through Obamacare.

At that point, the politics of loss aversion shift. Obamacare's major changes to existing insurance plans will be finished. It'll be the GOP's promises of repeal that threaten what people already have. As Johnson says, "We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare."

That's realization is how repeal-and-replace becomes criticize-and-reform. Johnson suggests ending the individual mandate and letting people buy less comprehensive plans. Sen. Kelly Ayotte wants to do more to promote health savings accounts. Almost all Republicans want to repeal the medical-device tax, and they may ultimately decide they want to repeal the excise tax, too. Medical malpractice reform remains an option, as does changing the way the law limits discrimination against older applicants.

Republicans who want to reform Obamacare remain the (growing) minority. But in another sign that Republicans see the politics of Obamacare changing, there's more talk of producing an actual Republican alternative before the 2014 election. Rep. Paul Ryan, for instance, plans to unveil the successor to his Patients' Choice Act act early next year. That, too, is an admission that something like the Affordable Care Act is here to stay, and Republicans need to begin proposing policy for a post-health reform world rather than fantasizing about a return to a pre-health reform world.