One unifying goal for the Republican Party over the past seven years has been the repeal of the Affordable Care Act, but now that the GOP controls Congress and the White House, it seems the party can't agree on what to do next. With fissures between Republican moderates and various conservative factions growing wider as GOP lawmakers return from the Presidents' Day recess, where several of them got an earful from constituents, GOP leaders have come up with a new plan, The Wall Street Journal reports: "Set a bill in motion and gamble that fellow GOP lawmakers won't dare to block it."
The new push to repeal and replace ObamaCare in three stages begins this week, premised on an acknowledgment that there is no plan that will get a comfortable majority in either chamber. Assuming no Democrats back the repeal bill, Republicans can lose two senators and 22 House members, giving really any GOP faction de facto veto power. House Speaker Paul Ryan (R-Wis.) and Senate Majority Leader Mitch McConnell (R-Ky.) are going to gamble on the "now or never" gambit anyway, WSJ reports, "because their entire domestic policy agenda, including a highly prized tax overhaul, rests on the health care maneuver paying off first."
Some GOP strategists even see this high-stakes gamble as an asset, because McConnell and Ryan could hang ObamaCare on any faction that tries to block the bill. "You're a Republican, you've been running to repeal ObamaCare, they put a repeal bill in front of you," said GOP health policy adviser Doug Badger. "Are you going to be the Republican senator who prevents ObamaCare repeal from being sent to a Republican president who is willing to sign it?" A lot rests on the answer to that question, though any "replace" effort needs support from Democrats to pass. You can read more about the GOP leadership's high-wire act at The Wall Street Journal. Peter Weber
President-elect Donald Trump says his plan for replacing the Affordable Care Act is nearly complete. In an interview with The Washington Post, Trump did not reveal the specifics of his replacement package, but promised, "lower numbers, much lower deductibles," and said "we're going to have insurance for everybody." He also said he plans to crack down on pharmaceutical companies, forcing them to negotiate on drug prices in Medicare and Medicaid.
Last week during a press conference, Trump said he wanted to see ObamaCare repealed and replaced at the same time. President Obama's signature health care reform law has brought health insurance to more than 20 million Americans, but Trump says it is "a complete and total disaster," and its repeal has remained a top priority for the incoming administration. When, exactly, the details of Trump's new replacement plan will be unveiled wasn't clear. Trump said he is waiting for Rep. Tom Price (R-Ga.) to be confirmed as secretary of health and human services. A confirmation hearing for Price has not yet been scheduled. As for gaining support from Democrats for his replacement plan, Trump said it won't be a problem. "I won't tell you how, but we will get approval," he said. Jessica Hullinger
Sen. Rand Paul (R-Ky.) said Saturday evening he would unveil his proposal for replacing ObamaCare the next morning, tweeting out a photo of the first page of his bill, captioned, "Coming this week: THE Obamacare replacement bill. Done drafting the bill & will be discussing on CNN Sunday AM and all week next week!" Speaking with CNN's Jake Tapper on Sunday, Paul sketched the rough outlines of his plan.
"Replacement should be the same day," Paul said, reiterating his critique of fellow congressional Republicans' "repeal and delay" idea. "Our goal is to insure the most amount of people, give access to the most amount of people at the least amount of cost." Paul praised the good intentions of the designers of the Affordable Care Act but said it includes too many mandates and has "broken the insurance model" in the individual market. Among other changes, his plan would remove some insurance coverage mandates that drive up premium costs to "legalize the sale of inexpensive insurance."
Watch two clips of Paul's conversation with Tapper below. Bonnie Kristian
— CNN (@CNN) January 15, 2017
— CNN (@CNN) January 15, 2017
The Democrats spent more than a year writing and refining the Affordable Care Act, and the Health and Human Services Department took another several years to get the various parts up and running. Republicans say the complexity of the law is part of its problem, and there's an open question of how fast they will repeal it, what they plan to replace it with, and when. At a CNN town hall forum on Thursday, House Speaker Paul Ryan (R-Wis.) aligned himself with President-elect Donald Trump's urging to replace the law as soon as possible, preferably simultaneously.
"We want to do this at the same time, and in some cases in the same bill," Ryan said. "So we want to advance repealing this law with its replacement at the same time." Republicans are moving "as quickly as they can," he said — the Senate has already started the repeal process — and when it comes to a replacement law, "we're working on this as fast as possible," adding that Republicans will act "definitely within these first 100 days" of Trump's administration.
Ryan also laid out some of his ideas for an ObamaCare replacement, saying "people with pre-existing conditions, no matter how much money they make," should have access to health insurance. A cancer survivor in the audience who identified himself as a Republican and onetime strident critic of ObamaCare told Ryan the law and President Obama had saved his life, then asked: "Why would you repeal the Affordable Care Act without a replacement?" Ryan said, "Oh, we wouldn't do that — we want to replace it with something better," and talked about state high-risk pools for people with pre-existing conditions. For people under 65 with cancer, for example, "we obviously want to have a system where they can get affordable coverage without going bankrupt because they get sick," he said. "But we can do that without destroying the rest of the health care system for everybody else."
You can read more about state high-risk pools, their shortcomings, and their traditionally underfunded history, and you can watch a 2-minute recap of Ryan's other remarks at the town hall — including his tough line on Russia, a "global menace led by a man who is menacing," and demonstration that yes, he does know how to dab — below. Peter Weber
Early Thursday, after voting down dozens of amendments from Democrats over seven hours, Senate Republicans approved a budget resolution measure officially beginning the process to repeal the Affordable Care Act, with no replacement yet proposed. The resolution, which passed on a partisan 51-48 vote — Sen. Rand Paul (R-Ky.) joined all Democrats present in voting nay — instructs relevant committees to draft ObamaCare-repeal legislation by Jan. 27. The House plans to vote on the resolution Friday.
In his press conference on Wednesday, President-elect Donald Trump appeared to back the "repeal and replace" strategy being pushed by Paul rather than the "repeal and delay" tactic GOP leaders in Congress appear to be pursuing. The health care law can be replaced "essentially simultaneously" with its repeal, Trump said, "probably the same day" if not within the "same hour." He did not offer any policy ideas or lay out a timetable. The budget resolution maneuver allows Senate Republicans to excise large parts of the law with a simple majority, but any laws to replace ObamaCare will likely need at least 60 votes. Peter Weber
Senate Republicans need only 50 votes to begin the process of dismantling the Affordable Care Act this week, but at least three GOP senators are publicly pushing back against the effort to repeal ObamaCare without a plan to replace it, and five GOP senators introduced an amendment Monday night to give Congress until March 3 to write legislation to repeal parts of the law. Under a budget resolution bill on which the Senate plans to vote Thursday, congressional committees have until Jan. 27 to write up the repeal plan.
Sen. Rand Paul (R-Ky.), who says he will unveil his own replacement proposal this week, has been leading the push to repeal and replace ObamaCare at the same time. He says that President-elect Donald Trump called him Friday evening to support Paul's strategy. "He called after seeing an interview that I had done [talking about] that we should vote on ObamaCare replacement at the same time," Paul told Politico on Monday. "I'd hate to characterize his opinion on it other than he agreed with me that we should do it that at the same time," he added. "There is momentum growing for it." He said he would vote for a standalone repeal bill if that was the only option.
Under the plans from GOP leaders, Republicans would repeal as much of ObamaCare as they can right away with a filibuster-proof budget maneuver, then come up with a replacement within three years. Any replacement measure would require at least 60 votes in the Senate, meaning eight Democrats would have to sign on. Then Trump would have to sign on. "I want to see the game plan in terms of how you actually enact replacement," Sen. Ron Johnson (R-Wis.) told CNN Monday. Sen. Lamar Alexander (R-Tenn.), chairman of the Senate health committee, said "it's much more prudent to figure out where you're going to go from here, and attempt to do it all at the same time," adding, "People will see some of the flaws in just repealing only."
Trump has a love-hate relationship with CNN, so Republicans who want to influence policy may want to take a page from Rand Paul's playbook and make their case on a program Trump actually watches. Peter Weber
“He called after seeing an interview that I had done ..."
Rand did MoJoe on Wednesday. DT called Friday. This is a new world order. https://t.co/UVvKUV7kcO
— Paul Kane (@pkcapitol) January 9, 2017
As the 115th Congress gavels into session Tuesday, one of the Republican Party's first orders of business will be beginning the process of dismembering the Affordable Care Act, the overhaul of the U.S. health care system crafted by Democrats in 2009 and 2010, with no public GOP plan to replace it. President Obama and Vice President-elect Mike Pence will meet Wednesday with their respective parties on Capitol Hill to discuss ObamaCare strategy, but on Monday, House Minority Leader Nancy Pelosi (D-Calif.) warned Republicans that if they repeal ObamaCare, they should be prepared for the fallout on their own. "It's the old thing of going into a china shop," she said: "You break it, you own it."
On CNN, Vice President Joe Biden had a similar message for Republicans, delivered in a very Joe Biden way. "I love these guys," he told Jake Tapper. "'We ran against the Affordable Care Act, how terrible it is, how premiums went up, we're going to repeal it!' Go ahead, repeal it. Repeal it now. See what happens. The idea that all of a sudden they can go back and start charging women more than men, pre-existing conditions don't matter." Obama and the Democrats "knew we had to improve the Affordable Care Act, knew from the beginning — we were looking for a partner," Biden said, using Social Security as an example of a program that was expanded and improved with bipartisan consensus.
In the Senate, Republicans are expected to rely on a procedure called budget reconciliation that will allow them to gut large portions of ObamaCare with just 51 votes, meaning they can lose two Republicans and still push the measure through. GOP leaders in the Senate are in favor of a lost "offramp" that would give them two years to come up with a replacement plan, but on Monday, Sen. Rand Paul (R-Ky.) warned against a "repeal and delay" plan or a "partial repeal" of the bill. "If Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of ObamaCare," he wrote at Rare. "Partial repeal of ObamaCare will likely win the day, but when the insurance companies come to Washington crying for a bailout don't say that no one warned of this preventable disaster." Peter Weber
On Tuesday night, President-elect Donald Trump repeated his pledge to repeal the Affordable Care Act, and as Vice President-elect Mike Pence met with congressional Republicans, the big question was how long before the repeal takes effect, with options ranging from six months to three years. Also on Tuesday, the two major trade groups representing hospitals warned Trump and GOP leaders in Congress that repealing ObamaCare could cost U.S. hospitals $165 billion by 2026 and force "an unprecedented public health crisis."
When Democrats wrote the Affordable Care Act over 14 months, they carefully balanced the needs of the various sectors in the health care industry, and the American Hospital Association and the Federation of American Hospitals argued in a Washington, D.C., press conference that the flood of uninsured patients would cause massive losses at hospitals. If it repeals the law, the hospital industry said, Congress needs to step in with financial aid. The groups, citing a study, estimated that based on the only ObamaCare repeal law Congress has passed (and Obama vetoed), 22 million more people will be uninsured in a decade, and the strain to hospitals from those patients would be "unsettling," as FAH president Charles Kahn III said.
Republicans have put together a repeal vote that can pass with a simple majority in the Senate, avoiding a Democratic filibuster, but any replacement legislation would need Democratic assent. Peter Weber