What is the row all about?
Donald Trump and the Republicans fought last year’s elections on a pledge to scrap Obamacare – officially known as the Affordable Care Act.
The flagship legislation of the Obama administration it extended health insurance to millions of Americans who up until then had been uncovered.
It also banned insurance companies from declining cover for people with pre-existing health conditions.
By compelling everybody to have health insurance – with fines for those who refused to buy a policy – the Obama administration believed the cost could be brought down by spreading the risk.
Why are the Republicans opposed to a law which gives people access to health care?
Republicans argue that Obamacare represents government overreach, with Washington interfering in the everyday lives of ordinary Americans.
They argue that what they describe as “socialised” medicine is denying choice and that a free market solution would bring the cost of health care down for everyone.
So Obamacare has been a success?
That is a matter of debate, even Democrats admit that Obamacare needs substantial reform.
The cost of health cover has soared over the past few years as insurance companies have found they have had to pay to treat a lot more sick people than had been expected.
Companies have just pulled out of Obamacare in some states because of unsustainable losses. Humana, for example, withdrew from the Obamacare’s market places in 11 states.
An estimated 45 counties, with 35,000 residents are at risk of having no insurer willing to offer Obamacare policies. According to the New York Times, a further three million people will have only one company available to them.
Opponents of Obamacare say this is because the law is too prescriptive and unworkable. Supporters of the legislation say it has collapsed because the Republicans have choked off the Federal funding to make it work.
Do the Republicans have a plan?
They have several.
The libertarian wing led by Kentucky senator and unsuccessful presidential candidate Rand Paul believes health insurance should be left to the free market.
He argues that competition between companies would slash prices with most Americans paying $1 a day for cover.
People would be free to pay for the cover they want and need, The best analogy is pet insurance which varies from the comprehensive and expensive to the cheap and minimal.
On the other wing of the party, Susan Collins from Maine believes that the best approach is to remove what she regards as the most prescriptive elements of Obamacare such as the “individual mandate” making health insurance compulsory, but keeping some of its other protections in place.
Somewhere in between have been bills proposed by the House of Representatives, known as the American Health Care Act and the Senate’s version, known as the Better Care Reconciliation Act.
What’s the problem?
The Republican solutions would see millions of people denied health insurance cover, according to the non-partisan Congressional Budget Office.
Even the stripped down “skinny repeal” of Obamacare could see 16 million people lose cover by 2026. Other versions put the figure well north of 20 million.
It would also see the cost of insurance for the sick and old soar.
Donald Trump, who has been pleading, cajoling and threatening Republicans to do something, described the House version of the bill as “mean”.
Surely the Republicans can push something through?
With a majority of only four in the Senate, it only takes three senators to bolt and the legislation falls.
On the moderate wing of the Republican party, there are at least two senators – Collins of Maine and Lisa Murkowski of Alaska – who have made clear they will oppose anything which slashes cover, especially in poor rural areas.
The only surprise was that it was John McCain who joined them rather than other likelier rebels including Dean Heller of Nevada.
Any bill which could be described as “Obamacare light” will run into trouble from a number of free-marketeers such as Rand Paul and Ted Cruz of Texas.
What happens now?
Obamacare remains the law of the land, but the continuing uncertainty means that insurers are set to impose another round of eye-watering rises next year.
Is there a solution? Any measure must have Democrat support. Donald Trump believes that the only way to get this is to let Obamacare collapse under its own weight.
Donald Trump: ‘Let Obamacare fail’
The ensuing chaos, he argues, would force the Democrats to negotiate rather than carry the blame.
Arguably a majority of Democrats and moderate Republicans could concoct something in the Senate.
But there is a danger it would run into serious difficulties with the House of Representatives if it was seen as being reworked Obamacare.