WASHINGTON – U.S. congressional Republicans completed the first step Friday toward their long-promised repeal of Obamacare, but now they face the much more difficult task of finding a way to unravel the massive health care law and replace it.
After promising to undo President Barack Obama’s health care law for seven years, Republicans will be trying to craft a repeal and replacement plan under scrutiny from all sides.
Lobby groups representing hospitals, doctors and patients want to make sure that individuals — particularly those who are sick — can keep access to coverage. Meanwhile, insurers, pharmaceutical companies and business groups want to get rid of taxes that help fund the law’s coverage expansion.
“Everything from here on goes through regular order and full process. Bills must be seen, and alternatives must be discussed and become available,” Rules Committee Chairman Pete Sessions of Texas said after the vote. “And votes will matter.”
“That’s why we came to Congress — to be big boys,” he added.
President-elect Donald Trump has made clear he expects swift action, even though he too has yet to offer his own plan.
“The Unaffordable Care Act will soon be history!” Trump tweeted before the House voted 227-198 Friday to adopt a budget resolution that would let Republicans push a repeal bill through the Senate without having to face a Democratic filibuster.
The House vote “went better than expected,” Majority Whip Steve Scalise of Louisiana said afterward, referring to strong doubts among some Republicans about the wisdom of rushing a repeal before outlining a replacement plan. “This is a signal that we are very serious about what we campaigned on for years.”
The road for Republicans will get much harder from here, when — as Sen. Bob Corker of Tennessee told reporters this week — they will be “shooting with real bullets.” He’s among a group of Republicans who want at least a clear road map for a replacement before repealing the law.
Republicans must figure out which pieces of the Affordable Care Act they can repeal immediately, and what replacements or stopgap measures can be put in place. Health-care industry groups have warned that repealing Obamacare without sufficient replacement plans could disrupt the individual market and jeopardize coverage for millions of people.
House Speaker Paul Ryan insisted that Republicans aren’t holding to any hard deadline for passing a new law.
“This will be a thoughtful, step-by-step process,” Ryan said on the House floor before the vote on the resolution, S. Con. Res. 3. At the same time, Majority Leader Kevin McCarthy has said Republicans hope to send Trump legislation by the end of February.
Friday’s vote, although “a critical first step” in Ryan’s words, was merely procedural. It allows the 52-48 Republican Senate majority to skirt the chamber’s usual 60-vote threshold to advance a repeal bill, requiring only a simple majority. The Senate narrowly adopted the budget resolution on a 51-48 vote early Thursday morning.
“We spent 2010, 2012, 2014, 2016 talking about ‘repeal and replace.’ So, no one really wants to stop the momentum on that,” Republican Representative Warren Davidson of Ohio said Thursday.
Under Obamacare, the uninsured rate fell to 8.9 percent in the first half of 2016 from 16 percent in 2010 as 20 million people gained coverage, mainly from Medicaid and on the law’s health insurance exchanges. Yet the law has faced criticism for climbing premiums, costs that some found to be too high, and its requirement that everyone have health insurance or pay a penalty.
The rub is that while Republicans campaigned for years to “repeal and replace” the 2010 law, they have never agreed on a single replacement plan. And while some portions of their eventual legislation can now advance in the Senate without being subject to filibusters, other parts will need Democratic support to reach the 60-vote margin.
“We’ve waited seven years to hear the alternative. How about one plan that we might have a chance to focus on?” said Richard Neal of Massachusetts, the Ways and Means Committee’s top Democrat, on the House floor. He said Republicans should instead be working with Democrats to improve Obamacare.
Trump’s pronouncements have scrambled GOP leaders’ plans to delay a replacement for as long as two or three years. Trump this week called for a replacement to occur “simultaneously, essentially,” prompting Ryan to insist that congressional leaders are “in sync” with the president-elect.
“Without getting into all of the legislative mumbo-jumbo, we want to do this at the same time and in some cases in the same bill,” Ryan said Thursday night during a town-hall meeting on CNN.
Rep. Richard Hudson of North Carolina said Friday there is “a lot of angst in our state” over an Obamacare repeal and that he participated in a telephone town hall with 12,000 people a day earlier.
“My constituents are freaking out about commercials they are seeing on TV about how they are going to lose their health care,” he said. Hudson said he tells constituents regarding Republican efforts to devise a replacement plan, “If Obamacare is working for you, we want to hear you say that, too.”
Freedom Caucus Chairman Mark Meadows of North Carolina said he believes a repeal could still happen in February, but that it could also carry over into March.
“Do I believe we can get consensus in the Senate? Not very optimistic that we could get 60 votes in the Senate” for a replacement, Meadows said.
Among the questions Republicans are struggling to resolve are how to treat states that expanded Medicaid under Obamacare and whether to immediately repeal all of the Obamacare taxes or keep some of them in place to ensure funding for a robust replacement.
Sen. Bill Cassidy of Louisiana, who has his own replacement plan, suggests keeping the revenue in place for now and replacing it later this year as part of a planned broader overhaul of the tax code.
There’s also a fight ahead over House Republicans’ insistence on using the health care measure to defund Planned Parenthood. Opponents of defunding include Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, though neither has said how she would vote if the House includes defunding in its bill.
Republicans can lose only two party members and still pass a repeal bill in the Senate, with Vice President-elect Mike Pence providing the tie-breaker.
Trump has said that Tom Price, his choice to run the Health and Human Services Department, will play a major role in creating a replacement plan. Price faces a hearing next week in front of the Senate’s health committee, although the key hearing for his confirmation hasn’t yet been scheduled. His confirmation could be delayed well into February.
Democrats, meanwhile, are lining up against the GOP tactics. Rep. Jim McGovern of Massachusetts said that by moving forward without telling members what their replacement plan is, Republican leaders are “running the House of Representatives like a Kremlin.” He joked that “the plan is to take two tax breaks and call me in the morning.”
House Minority Whip Steny Hoyer of Maryland earlier this week didn’t directly answer whether Democrats might ultimately work with Republicans in devising a replacement for Obamacare. “What we’re for is improving and making it work better,” he said.
But on the “hypothetical” that Democrats can’t stop the health care law from being repealed, he said, “that’s not going to stop our feeling that we ought to make sure that Americans have health care security.”