Many conservatives throughout the country are calling for the rapid repeal of Obamacare. President Trump has promised the abolition of the Affordable Care Act and the replacement with something that broadens health care access, decreases costs, and improves the quality of care.

A tall order, but no wonder: Consumers face staggering price hikes for individual insurance policies. Premium hikes average 25%, much more in some places. Deductibles for some silver plans are $6000 for individuals, $12000 for families; that’s a lot of money before coverage kicks in. The result is that 51% of participants owe more than $1000 in medical bills. In many cases, you can’t really call Obamacare much more than catastrophic care insurance.

Yet, Democrats point to 20 million more insured Americans as “proof” that Obamacare is working. That’s only true, however, if the definition of “working” means calling just about anything health insurance.
It seems that repeal should be widely acceptable to the public. Despite this, the end of Obamacare is no sure thing and presents significant danger politically to Republicans.

The full repeal of Obamacare cannot occur without 60 votes in the Senate, assuming an almost certain Democrat filibuster. With Senators Chuck Schumer (D, NY) and Bernie Sanders (I, VT) organizing pro-Obamacare rallies throughout the nation and filling Republican town halls with its supporters, the likelihood of 8 Democrats crossing the aisle to vote for repeal seems the stuff of dreams.

To counteract this, Republicans passed a Budget Reconciliation bill which increases their hold on the purse strings that fund the program. Stripping Obamacare of money piecemeal, however, will throw the entire system into chaos when an orderly transition is needed.

Here’s the trap: Republicans should realize that, while Obamacare is the albatross around the Democrat Party’s neck right now, what happens in the future is on the GOP. Once an entitlement has been given, it’s very hard to take away. Any action that uninsures millions of people is doubtful to be popular. The Democrats will characterize it as just another example of mean-spirited, uncaring Republicans trying to “Make America Sick Again.”

Here’s this future Democrat ad after a hastily and poorly-thought out repeal of Obamacare: “Here’s poor John Q. Public with his wife and six kids. He and 10 million other patriotic Americans were discarded by Republicans like an empty beer can when the Affordable Care Act was repealed. Now’s the chance for John and millions of you voters who lost health insurance to stick it to the insensitive, nasty, nefarious GOP by voting Democrat this election.”
Get the idea?

If Republicans run hastily to repeal without a replacement that keeps the grand majority of these folks covered, there will be consequences at election time. The Democrats are counting on this likelihood to make gains both nationally and on the state level in 2018.

Some Republicans bemoan the Medicaid expansion that now covers 61 million people in most states, including some with Republican governors. But Medicaid is the safety net for those that can’t afford to pay for health insurance on their own; it may need to stay in place. Also, consider a “grandfather clause” that allows those insured under Obamacare to remain covered for a period while a replacement is enacted. Once in place, there would be a natural transition to the new system.

In the Trump era, we have seen changes come fast and furious. President Trump, however, states that he wants to broaden access to healthcare, not diminish it. If the Republican congress fails to assure the continuation of health coverage for the millions currently insured through the Affordable Care Act, there will be hell to pay.