Bluntly, if the Republicans repeal critical sections of the Affordable Care Act using budget reconciliation, the ACA is effectively dead. There is nothing that Democrats can do at this point to save it.
The only hope we have is that as a repeal becomes more of a reality, vulnerable Republican senators living in states with heavily impacted voters may actually cross the aisle and vote against the repeal. This isn't as unlikely as you might think. Republicans are now the dogs that caught the car. They expected Hillary Clinton to win and to use their fight against Obamacare to fuel their state and Congressional ballot races forever.
Now, there is absolutely nothing stopping them from trashing the Affordable Care Act and the more intelligent, and less idealistic, will realize that car fenders taste like crap.
If we can't stop the GOP from repealing the individual mandate, rolling back the Medicaid expansion, and killing the premium tax credits, though, then the Affordable Care Act is dead. All that's left then is to hang this destruction around the collective Republican neck, and stand back and let them strangle on it.
The second part of the destruction of the ACA is its "replacement". You know, and I know, that anything the Republicans come up with won't be an effective or viable replacement. The only replacement that would work is to put the individual ACA elements back into the replacement, with maybe a few tweaks to fix some those aspects Democrats have been wanting to fix for the last several years. Paul Ryan and Tom Price would virtually froth at the mouth in their Randian reaction to the very idea.
However, not having some kind of replacement will destroy major chunks of the entire healthcare system. Republicans smugly think that Congressional Democrats will go along with their abomination because we're actually concerned about things like destroying the healthcare system.
We could filibuster the replacement, in which case the Republicans will blame the Democrats for the state of the healthcare system. We could also grudgingly go along with the replacement, salvaging what bits we can along the way. If we do, we'll get the blame for the bad bits, and the GOP will take credit for everything else.
It's seemingly a lose/lose situation. However, there is a third option.
When the Republicans vote on a replacement, Democrats can, as a united whole, vote against it. But, we also won't filibuster the Republican vote. No deals. No attempt to salvage whatever tattered remains of the ACA we can. In a tug-of-war, sometimes the best option is to just let go.
The replacement will pass, but without any Democratic support. As the Affordable Care Act passed without any Republican support.
The ACA is successful and could continue to be even more so, but it's not been given a chance. The Republicans hung the Affordable Care Act around Democratic necks and used it to fuel their Tea-Party take over of the White House, state governments, and Congress. So we'll hang their pathetic replacement around their necks. I suspect they won't like the results.
Then when sanity returns to the Presidency and Congress, as it inevitably will, we'll go back to work.
