With congress set to vote on the Republican replacement for Obamacare, a Missouri health economist thinks the GOP is in a shaky position.

Washington University Health Economist Tim McBride

Washington University Professor Tim McBride contends President Trump and the party have promised too much for the plan to be functional.

Taken together, Trump and House Republican have said the plan would do several things including; allow people who secured insurance under the Affordable Care Act (ACA) to maintain coverage; replace the expansion and lower the costs of Medicaid; eliminate the individual mandate; leave in place popular provisions; eliminate all or nearly all tax increases enacted to pay for the ACA.

“By now, most if not all of the GOP members of Congress realize that achieving all of these goals is impossible,” said McBride.

He says the problem started when Trump and some Republicans said no one would lose coverage.  “Basic problem there is, if you’re going to do that, you have to put in place Medicaid expansion and marketplace reforms to keep the same number of people covered as there currently are.  But that’s going cost money, and they want this to cost a lot less money.”

McBride says it’s impossible to repeal the taxes which pay for Obamacare and cover the same number of people because the subsidies in the plan are what allow poor people to afford coverage.  Repeal of Obamacare taxes removes $900 billion from health care spending over 10 years.

McBride notes Republicans spent many years vowing to repeal Obamacare, but failed to find a replacement they could all agree on.  “There were always proposals out there to do this, that and the other thing” said McBride.  “But they never got together and put all their members together to agree on one approach.  And that’s turning out to be a lot harder than they thought.”

House Republicans can’t find a consensus on what to do.  The conservative Freedom Caucus is focused on repealing the plan and reducing government spending, while GOP leadership favors a replacement which includes element from Obamacare.

McBride says he hopes the party will adopt his approach of repealing and repairing the plan, rather than repealing and replacing it.

“What hopefully would happen is they would go in there and change the things that aren’t working and come to a bipartisan agreement.  That’s what I hope happens.  That would be the best thing to do.”

McBride, who’s been following legislation for many years, contends sweeping measures such as the ACA are never perfectly drafted.

But because of the partisan divide in Congress, he says changes to fix the health plan could never be made and it’s largely in its original form seven years later.

McBride thinks the current Republican plan will squeak through the House, but hit a roadblock in the Senate.  At least four GOP Senators have said they will not support the House bill as drafted.  The measure would die if three of them aren’t somehow persuaded to vote for it.

Figures from the non-partisan Government Accountability Office show that with the plan, 24 million fewer people will be covered over 10 years while the ongoing rise in the cost of insurance premiums will be reduced by 10% over the same time period.

Republican House leadership has been planning to vote on the measure Thursday.

In addition to his position as a professor at Washington University, McBride also heads Missouri’s Medicaid Oversight Committee.