Even a purist like Marco Rubio wants to keep some popular provisions:
I’m with a small group of reporters in a D.C. coffee shop, chatting with Florida Republican Senate candidate Marco Rubio. He just mentioned that there are two parts within the Obamacare legislation that he doesn’t want repealed*. The first is the ban on insurance companies denying coverage based on preexisting conditions and the second is that he thinks that children up to age 26 should be allowed to “buy into” their parents’ coverage.
Ramesh Ponnuru accurately retorts:
Apparently he wants to repeal Obamacare and then re-pass that provision—although it's not clear from his non-clarifying clarification.
One more time: If you can buy insurance at the same price whether you're sick or healthy, you have no incentive to buy it when it's healthy. Only sick people will buy it, and its price will rise and rise. If you want to have this ban and preserve something called insurance, you have to force everyone to buy it. You can't get this ban on an a la carte menu, as popular as it would be.
Ponnuru is correct. But this also helps explain why NR's crusade for health care reform repeal is doomed. The previous system was intolerable to the public, and only inertia and political dysfunction kept it going. The Republicans had a popular stance of supporting all the popular elements of health care reform, like the ban on preexisting conditions, without any of the unpopular elements. It's a good slogan for building opposition to reform. But it's an unworkable plan for legislation, for the reasons Ponnuru cites.
That's why conservatives have urged the GOP to just support a clean repeal bill, without also having to assemble a majority for an alternative bill. The problem is, that leaves you supporting an intolerable status quo ante. It's so intolerable even Marco Rubio won't endorse it. That's why turning health care reform into "health care repeal" is a winner for Democrats, and why Republican leaders had to be dragged into endorsing it. Repeal divides the GOP base from the center.