Republicans are facing a basic political problem on Obamacare: If they fail to repeal the unpopular law, they will be reneging on a central promise that they have been making to voters for years, but if they go ahead with repeal, they’ll be under fire for disrupting the insurance arrangements of millions of Americans.

As opponents of the law watch this play out, they should beware of ways that Republicans could try to square the circle – making changes to Obamacare that they claim constitute repeal, even though they leave many key elements of Obamacare intact. Call it Repeal In Name Only – or RINOcare.

So, what might fake repeal look like? For one potential example, look no further than Vice President-elect Mike Pence’s Indiana.

In 2014, Gov. Pence found himself in a similar situation as Republicans when it came to the issue of whether to participate in Obamacare’s Medicaid expansion. On the one hand, he had presented himself to voters as a fierce opponent of Obamacare and knew he would take heat from conservatives were he to support the expansion. But on the other hand, he was under pressure from hospital lobbyists and other proponents of expansion to take the federal money and extend coverage to more low-income residents.

So, Pence consulted with Seema Verma, who happens to be Trump’s pick to head the Centers for Medicare and Medicaid Services, to come up with a solution that would allow Pence to expand Medicaid while claiming he was enacting free market reforms. With Verma, Pence took the federal taxpayer money, but added some window dressing to sell it to conservatives.

For instance, unlike traditional Medicaid in which qualifying individuals typically receive a standard government benefit, the Indiana version offers high-deductible health plans that are paired with health savings accounts and the state requires modest premium payments. Yet none of this could change the fact that Pence caved into Obama and added billions of dollars to state and federal budgets.

If this type of approach were taken by Republicans at the federal level, it’s easy to see how they could institute reforms to Medicaid that provided more flexibility to states to experiment with different ways of implementing the program, encouraged more private options, and inserted various other cosmetic elements, without substantially cutting Obamacare’s Medicaid spending.

It’s also possible that Republicans could take a similar approach to the other major element of Obamacare – the exchanges. Republicans could, through legislation and action by the Department of Health and Human Services, unravel many of the law’s regulations, and give more power to the states over insuring their own populations. But at the same time, they could replace Obamacare’s subsidies with costly tax credits toward the purchase of insurance.

In the midst of a blizzard of changes, Republicans could argue that they’re following through on their promise to get rid of Obamacare, assuming that their voters won’t understand the nuances of health policy. It isn’t difficult to foresee a scenario under which President Trump signs such a bill into law, declares Obamacare repealed and replaced, and calls anybody who disagrees liars and a frauds.

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Though during the Obama administration, Congressional conservatives could be counted on to resist such posturing, now that a Republican is in the White House, things are likely to change. Conservatives pointing out that Trump isn’t really repealing the law would be treated as sticks in the mud as Trump unleashes his army of supporters against them. Keep in mind that within weeks of his election, Trump already has Rush Limbaugh giving cover for his massive Keynesian-style infrastructure spending plans.

So how can conservatives tell genuine repeal from fake repeal? One of the easiest ways is to look at spending levels. In a Thursday report, the Congressional Budget Office estimated that a straight repeal of the law’s coverage provisions (that is, the Medicaid expansion and exchange subsidies) would reduce spending by $1.75 trillion. In addition, repeal would cut taxes by over $1 trillion, according to an earlier CBO report. When combined, if legislation to repeal and replace Obamacare does not cut spending on Medicaid and insurance subsidies or reduce taxes by an amount at or near those amounts, it can’t be called true repeal.

The reason why spending levels are so important is that any policy to replace Obamacare has to assume that Democrats will be back in power some day. If Republicans keep the spending levels largely in place, it would be relatively easy for Democrats to restore regulations, reassert federal control, and incrementally increase subsidies. However, if the spending levels are wiped out, a new Democratic administration would be back to square one, forced to come up with trillions of dollars in new spending.

Instead of falling in line as they often do when a Republican is in the White House, conservatives should be preparing to hold Trump and Congressional Republicans to their word when it comes to repeal. They should beware of RINOcare.

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