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Monkey Trap

A "monkey trap" is sprung when a victim is so reluctant to surrender a temporary gain it fixes him in place allowing his enemies to inflict long term destruction.  He can escape by letting go but it never occurs to him; and so  ‘the monkey is trapped not by anything physical, but by an idea, unable to see that a principle that served him well has become lethal’.  The Patient Protection and Affordable Care Act, otherwise known as Obamacare, has been death on political monkeys.   Its first victim was the Democratic Party which having hailed it as a step on the road to a single payer health care system, were so blinded to its financial and practical faults that they let it drag them to oblivion in the 2014 midterm and 2016 presidential elections rather than letting it go.

But its lethal career may not be over.  Now it is Obamacare repeal-and-replace process which threatens to trap the administration of Donald Trump.  If single-payer is the Holy Grail of liberal health policy, its conservative equivalent is a competitive health insurance market.  In keeping with his election promises DJT must find some way to swap out the government-centric Obamacare engine with a completely different motor while keeping the car running -- that is to say without disrupting the public's health coverage. The public expects the administration to do radical things but without causing severe inconvenience. To do this Paul Ryan has devised a three step plan.

Proponents of the American Health Care Act [the GOP Obamacare replacement] claim that full repeal of Obamacare cannot be accomplished in one bill due to limitations imposed by the budget reconciliation process. House Speaker Paul Ryan, R-Wisc. made this point at length in a press conference held last week. Republican leadership in the House of Representatives insists that the best way to move forward on repeal is in a three-step process.

Step one is to use budget reconciliation to repeal Obamacare taxes, eliminate the individual and employer mandates, tweak the subsidies, and repeal some minor regulations. Step two is to let Department of Health and Human Services Secretary Tom Price take administrative action to repeal the rest of the regulations and administer free-market reforms via agency promulgation. Step three is for Congress to legislate further reforms that cannot be included in reconciliation.

It's exactly the kind of procedure-centric plan Ryan would come up with. The trouble with this approach according to critics like Arkansas Senator Tom Cotton is that step one risks strengthening most of Obamacare's most objectionable features (from the GOP viewpoint) before any progress from steps two and three even begin kick in. The Senator from Arkansas Tweeted his objections:

1. House health-care bill can't pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don't get it fast.

2. GOP shouldn't act like Dems did in O'care. No excuse to release bill Mon night, start voting Wed. With no budget estimate!

3. What matters in long run is better, more affordable health care for Americans, NOT House leaders' arbitrary legislative calendar.