"Now that they’ll be held accountable for the changes they make, Republicans aren’t all sure they want to get rid of all that. Republicans might want to kill the taxes, but that would mean they’re going to have trouble paying for a replacement. Republicans would like to convert those subsidies to refundable tax credits, but it’s not yet clear how Republicans would design them. Many Republican states took the Medicaid expansion — and saw their uninsured rates plunge. They like the flexibility involved in Republican plans to turn Medicaid into a block grant, but they don’t want to give up the money they’re getting from the federal government."
"In short, this stuff is complicated, especially if you want to avoid the enormous public backlash that would increase exponentially if you just repealed the law. There may be no way to avoid that backlash, particularly since everything Republicans are considering is guaranteed to produce more uninsured people, higher out-of-pocket costs, and enormous disruption to the system (and that’s if it works as planned). But Ryan and other GOP leaders are hoping to finesse it all with a carefully constructed Jenga tower of a bill that minimizes the political damage they’ll suffer. Some parts of the ACA (the popular ones) will likely be kept in some form, and the whole thing will be rolled out gradually, perhaps with a delay that pushes the most dangerous parts of the transition past the 2018 midterm elections (or even the 2020 elections). And it’s already clear that Ryan doesn’t want to rush into anything when the political stakes are so high."
From WAPO column by Paul Waldman
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