The 115th Congress is already on course to repeal Obamacare, fulfilling a promise Republicans made six years ago when Democrats passed the landmark health care legislation nicknamed for the President.

West Virginia’s Republican members of Congress are all in on the abolition. Senator Shelley Moore Capito, who voted more than 40 times for repeal when she was in the House, believes the opportunity has finally arrived to “repeal and replace,” but it’s not that simple.

First, Republicans say they want to keep parts of the Affordable Care Act that people like, such as reasonably priced insurance options for people with pre-existing conditions, allowing parents to keep children on their policies until age 26 and expanded Medicaid coverage for low-income families.

There’s a lot at stake here for our state. Over 177,000 West Virginians now have insurance under Obamacare’s Medicaid expansion and another 37,000 have coverage through the exchanges.

“You will not be kicked off of your coverage,” Capito told me on Talkline this week. “There’s going to be a time when we’re going to figure out the best way to get better coverage for those people, whether it’s called Medicaid or an expanded Medicaid, I think those details will be worked out later.”

It’s that “later” part that bothers Senator Joe Manchin.  The West Virginia Democrat won’t vote to repeal Obamacare until there is a viable replacement.  “I’m not betting on the Congress,” he told me on Talkline. “I’ve been here six years and they haven’t fixed anything.  I’m in the ‘fix and repair’ category,” he said.

Meanwhile, health care providers are wondering what repeal and replace means practically, making it difficult for them to plan ahead.  “There’s a lot of uncertainty and unknowns,” said West Virginia Hospital Association President and CEO Joe Letnaunchyn. “We have a lot of questions and a lot of concerns about how it would impact the hospitals, the patients we serve and how we’re paid for those services.”

Politically, once the ACA is repealed, Obamacare becomes Trumpcare. The president-elect and the Republicans are going to take ownership of what happens next. The GOP believes (or perhaps hopes) that health care under their guidance will be better, that they can avoid the mistakes President Obama and the Democrats made.

But the health care delivery system in this country is unimaginably complicated, and because it involves matters of life and death, it’s an emotional issue that touches everyone. Republicans should have learned one thing from the Democrats—any changes that are not bipartisan that don’t work will cause serious political damage.

Republicans have been clamoring for this moment, and Present-elect Trump has called Obamacare a disaster. It’s their turn now, and the stakes couldn’t be higher.


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