We're not in ACA Repeal-and-Replaceville. We're in Cassidy-Collinstown

Peter Suderman argues that The GOP Accidentally Replaced Obamacare:

Republicans, having failed to repeal Obamacare, have stumbled, almost accidentally, into replacing it. For better and for worse, and with little coherent vision at work, they are making Obamacare their own. And over time, they are likely to embrace it.

There's a good degree of truth in this. Suderman runs through the panoply of Republican legislative and administrative whacks at the ACA's structure and benefits on the federal and state level: individual mandate repeal; creation of a parallel market of non-ACA-compliant plans; regulatory hurdles to Medicaid enrollment aimed particularly at the ACA Medicaid expansion population; repeal of the Independent Payment Advisory Board for Medicare. And Suderman adds a creative future-cast twist: If Democrats take power and pursue a fully or quasi-single payer system, Republicans may end up defending the relatively moderate -- and Republican-moderated (or adulterated) -- status quo, i.e. the ACA.

Suderman's neat conceit leaves a core factor out of the equation, though: funding.

Repair, not replace -- rebranding, or real change? Watch the Medicaid expansion

The battle over ACA repeal-or-whatever is going to go through a lot of twists and turns and bold assertions that will fade like morning dew. Still, the latest Republican messaging and positioning seems at least potentially significant. From The Hill's Peter Sullivan:

Key Republican lawmakers are shifting their goal on ObamaCare from repealing and replacing the law to the more modest goal of repairing it...

“I'm trying to be accurate on this that there are some of these provisions in the law that probably will stay, or we may modify them, but we're going to fix things, we're going to repair things,” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), a key player on healthcare, told reporters Tuesday.

Fight ACA insta-repeal: Contact strategically placed friends and family

Congressional aides and other political insiders often say that elected officials pretty much discount calls and letters from those outside their own constituency. Taking that received wisdom to heart, I have been pitching friends and family in states with Republican senators to call or email those senators and urge them to reject ACA "repeal-and-delay" -- and encouraging people in my local advocacy group, BlueWaveNJ, to do the same.

Using what comes to hand, I thought I'd share my template letters here -- that is, letters to friends and family in Texas and Pennsylvania. Texas first, because interesting news prompted me to cook it up yesterday.  But the PA letter  is more of a general template, with more resources and context Ohio is next for me. Each one includes contact info and state health facts, courtesy mainly of Families USA's tool to pull same.

So if you've read this far, would you please call or write Unc in Ohio or former college roommate in Louisiana and ask them to call/email their senators? Please use/share/adapt the PA template letter (below the TX one) if it's useful - or maybe just the link library at the end of it.  Thanks...

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Dear AUNTIE IN TEXAS:

Texas Senator John Cornyn today said something very interesting about ACA repeal:

A group of Republican governors met with Republican members of the Senate Finance Committee on Thursday, and some expressed concerns about the number of people who could lose insurance once GOP lawmakers repeal the Affordable Care Act.

One of the top concerns is what will happen to individuals who became eligible for Medicaid with its expansion under Obamacare. The Senate's No. 2 Republican, however, promised that no one who got coverage under Medicaid expansion will lose it.

When Cornyn was asked if he was concerned about people who've benefited from Medicaid expansion losing coverage, he said it was a shared concern.

"Were all concerned, but it ain't going to happen," Cornyn said. "Will you write that down... It ain't gonna happen."

A good day for the ACA

While there will doubtless be many shifts and turns in the battle over the ACA, the road to repeal has seemingly got steeper for Republicans in the last couple of days. Some good developments:

1) Trump blew in with his promises to cover everyone, with low deductibles, and to enact his magic replacement at the same time as ACA repeal. That would seem to make it harder for Republicans in Congress to proceed with repeal-and-delay.

2) The Congressional Budget Office, traditionally the arbiter of the fiscal viability of proposed legislation, did the Urban Institute one better and estimated that the repeal-and-delay bill Republicans passed in late 2015 (vetoed by Obama) would un-insure 32 million people in a decade.

3) Media coverage pretty universally noted that the Jan. 15 rallies reflected deep support for the ACA and stiff resistance to repeal from its proponents. The NYT's Robert Pear, generally caustic about the ACA, put it this way: