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COMMENTARY

The political clamor about an impending “repeal and replace” of the Affordable Care Act is loud, aggravating and completely in vain unless Republican leaders in Congress can come up with an actual plan for American health care that would improve lives.

That places GOP lawmakers in an awkward position. Since the ACA ultimately included a great number of traditionally Republican suggestions for providing broad coverage to citizens, one wonders what’s even left in their lunch pail of acceptable health policy.

To that end, it’s important to remember some specific requirements of the ACA that may be difficult for even the most conservative Congress to repeal.

For starters, House Speaker Paul Ryan, Senate Majority Leader Mitch McConnell and incoming President Donald Trump will engender a great deal of public discontent if they attempt to repeal the ACA’s prohibition of insurance company denials based on patients having “pre-existing conditions.”

Mandatory coverage of pre-existing conditions was one of the public’s primary demands when the ACA took form in 2009. (Michael Moore made an entire documentary about how crappy American health insurance was, remember?)

The Kaiser Family Foundation released a report in December estimating that 52 million Americans have the sort of pre-existing conditions for which private health insurers previously used to deny payment prior to the ACA.

Should Trump et al offer a plan that fails to protect this public benefit — and so many others, such as parents’ ability to keep children on their plans until age 26, expanded Medicaid funding and the prohibition of lifetime payment caps on insurance plans — his presidency might ironically wade into the same dark waters that Barack Obama’s did. Obama spent much of his post-election political capital passing health care reform. Trump appears destined to start his presidency by attempting to re-can that same pile of worms.

And how will that really work anyway?

Industry has kept moving forward

While politicians have continued to bark about stopping Obamacare for the past seven years, the health care industry has kept churning out quarterly reports. As such, anyone who thinks America’s health care delivery system has not fundamentally changed since 2009 is mistaken. Electronic medical records, patient-centered care models, incentivized reimbursements and skyrocketing insurance deductibles have all arrived and are here to stay. In many senses, they were all on the way prior to the ACA.

As a result, no conceivable “repeal” of Obamacare will alter the course of millions of dollars of industry investment that has taken place in the past seven years. Sure, lawmakers can probably muster the political will to scrap the ban on physician-owned hospitals and the cap on health insurance-company profits, but they won’t be tossing hundreds of pages of already-implemented Medicare policy in the trash overnight.

Furthermore, GOP leaders may face their biggest test when it comes to the individual health insurance mandate, the ACA’s most controversial feature, which forces all Americans to obtain coverage or be subject to a tax penalty.

While insurance companies would like to see a few of their regulations repealed, any business will inherently fight like hell to retain a federal mandate that says the public must buy its product. (Side note on following the money: Insurance companies are some of America’s strongest pro-choice voices behind the scenes. Ask yourself what costs less: an abortion or a baby?)

Thus, insurance companies may be the most interesting (and frustrating) players to watch in this impending repeal-and-replace debacle because they may simultaneously fight for parts of the ACA to go while arguing that the government-built health insurance exchanges and the individual mandate must remain.

And that’s why America needs to be presented with an actual plan amidst all of this repeal-and-replace rhetoric.

Since the GOP used to support the individual mandate and state-based exchanges (think Clinton-era health policy debates), it will be interesting to see what they support now in a 2017 health care arena so strongly shaped by the ACA already.

Of course, Ralph Nader would still argue for single-payer Medicare For All. Bernie Sanders would, too. And a Harvard professor did so in a USA Today commentary Friday.

In fact, 58 percent of Americans in May supported replacing the ACA with a government-funded single-payer plan.

Perhaps it’s worth noting that Trump has previously supported single-payer, too?

Probably not.