After eight years Republicans are finally in a position to repeal the Affordable Care Act.  Many caution that repeal without concomitant replacement will lead to chaos in the insurance markets with millions losing coverage.  These fears are overstated. Yet replacement should accompany repeal for another reason – to maximize the chance that a good replacement package can be enacted.

Republicans hold 52 Senate seats.  While a repeal of much, but not all, of the ACA can occur with a simple majority vote through the reconciliation process for items with budgetary implications, repealing the entire law and enacting a replacement will require 60 votes. Republicans need help from at least eight Democrats.  They have the best chance of getting it if they combine repeal with a comprehensive replacement package that includes individual items that appeal to specific Democrats who will, therefore, be willing to vote for the entire package.

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