President Donald Trump had an epiphany last week about the seven-year old Republican crusade to "repeal and replace" Obamacare. After his past promises of "insurance for everybody' and "I am going to take care of everybody," Trump had an admission to make to the nation's governors on Monday:

"I have to tell you, it's an incredibly complex subject. Nobody knew that health care could be so complicated."

Of course, almost everyone knew that. After all, U.S. health care spending has reached $3.2 trillion a year. That figure doesn't just represent almost 18 percent of the nation's gross domestic product; it's nearly double the investment that America's economic competitors make for health care systems generally rated better than our own. Complicating matters further, the United States has not one but four health care systems: private insurance for individuals and families provided by employers or purchased in the market, Medicaid for low-income Americans and elderly nursing care, Medicare for senior citizens and the disabled, and the VA system for military veterans.
But the evident frustration of the Trump administration and GOP leaders in Congress in fulfilling their pledge to replace the 2010 Patient Protection and Affordable Care Act has two causes of the Republicans' own making. First, "replacing Obamacare" has a very specific meaning. For starters, any GOP alternative must not only enable insurance for over 20 million Americans as the ACA does, but must also prevent millions more from losing coverage during any transition period. Crucially, a true replacement for Obamacare must likewise require coverage for mammograms, colonoscopies, annual check-ups and pre-natal care. Just as important, no plan touted as an alternative can roll back the ACA's extensive protections against the worst practices of the insurance industry, including refusing to insure those with pre-existing conditions, using "rescission" to drop coverage for the newly sick, imposing annual and lifetime benefits caps and barring coverage for adult children under 26 on parents' policies. And no Republican plan is a "better way" if it increases the national debt, something the nonpartisan Congressional Budget Office (CBO) has always concluded Obamacare does not.

That brings us to the Republicans' second self-inflicted wound. President Trump, House Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) have set very high expectations for their Obamacare replacement proposal. Yet almost seven years after McConnell declared his party's slogan for the 2010 midterm would be "'repeal and replace', 'repeal and replace', 'repeal and replace,'" the GOP hasn't come close to a blueprint that can check off all the boxes described above. There's no mystery as to why. For a generation, the GOP has never offered a serious plan to provide universal health care coverage for the American people. Instead, Republicans have only put up straw men as part of their scorched-earth campaign to prevent Democrats from succeeding in doing so.
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