GOP May Delay Obamacare Replacement for Years
Republicans are setting up a high-stakes deadline to replace the health care law.
By Rachael Bade and Burgess Everett POLITICO December 1, 2106
Congressional Republicans are setting up their own, self-imposed deadline to make good on their vow to replace the Affordable Care Act. With buy-in from Donald Trump’s transition team, GOP leaders on both sides of the Capitol are coalescing around a plan to vote to repeal the law in early 2017 — but delay the effective date for that repeal for as long as three years.
They’re crossing their fingers that the delay will help them get their own house in order, as well as pressure a handful of Senate Democrats — who would likely be needed to pass replacement legislation — to come onboard before the clock runs out and 20 million Americans lose their health insurance. The idea is to satisfy conservative critics who want President Barack Obama’s signature initiative gone now, but reassure Americans that Republicans won’t upend the entire health care system without a viable alternative that preserves the law’s popular provisions.
“We’re talking about a three-year transition now that we actually have a president who’s likely to sign the repeal into the law. People are being, understandably cautious, to make sure nobody’s dropped through the cracks,” said Senate Majority Whip John Cornyn (R-Texas).
The tentative strategy is reminiscent of Capitol Hill’s infamous “fiscal cliff” days, when Congress imposed simultaneous deadlines to raise the debt ceiling, extend expiring tax cuts and fund the government. The hope was that it would create irresistible political pressure to get behind a bipartisan mega-fiscal deal.
This time, however, it’s access to health care for tens of millions of people that’s on the line.
“I think once it’s repealed, you will have hopefully fewer people playing politics and [instead] coming together to try to find the best policy,” House Majority Leader Kevin McCarthy (R-Calif.) said Tuesday. He added that when there is “a date certain that something’s going away … you know you have to have something done.”
The strategy presents significant risks. The fight over a replacement is guaranteed to be messier than the cathartic repeal vote. Giving themselves as many as three years to figure it out shows that Republicans are well aware of how tough it will be.
Trump has made the GOP’s task harder by saying he wants to preserve elements of the law that protect people with pre-existing conditions and allow young people to remain on their parent’s health insurance until they turn 26 years old, pricey provisions that will complicate Republican efforts to merely gut the law. Plus, there are millions of people now relying on Obamacare’s Medicaid expansion that the GOP will be loath to cast off the insurance rolls.
And following a repeal vote, insurance companies could bail on Obamacare immediately, even if there is a three-year grace period, leaving people with no health plans.
“The flaws in Obamacare are obvious to me. The solutions are much harder,” said Sen. Lindsey Graham (R-S.C.).
Moreover, there is already some intraparty turmoil over the repeal timeline, starting with Lamar Alexander, chairman of the Senate Health, Education, Labor and Pension Committee. He’s pressing to have a replacement plan ready before tackling repeal, which could significantly delay things, given that Republicans are far from a consensus on what kind of replacement they want.
The Tennessee Republican has notably began swapping the words “repeal and replace,” used by Republicans for years, to “replace and repeal.”
“There’s an eagerness to address it, so I think there’s no doubt we’ll start immediately to replace and repeal Obamacare, but the president-elect has said that the replacement and the repeal need to be done simultaneously, and that means to me that we need to figure out how to replace it before we repeal it,” he said.
Most Republicans, particularly in the House, want to repeal as soon as possible and deal with the replacement later. Rep. Tom McClintock (R-Calif.), a staunch conservative, said the party must “take no chances; do it now.” And House leadership has heard those demands clearly.
“This law, you have to remember, is hurting families in America,” said Speaker Paul Ryan during a news conference on Wednesday. “So we have to bring Obamacare relief as fast as we possibly can in 2017.”
The Obamacare repeal road map Republicans are sketching out is complicated. They are already eyeing passage of a fiscal 2017 budget as soon as January to unlock a fast-track tool that would allow the Senate to clear a repeal by a simple majority. Republican aides predicted the entire repeal, done through so-called reconciliation, will be finished in the first 100 days of Trump’s presidency — though that timeline is fluid.
Top Republicans are keen to show voters they’re working to immediately deliver on their campaign pledge to curb the health law. After campaigning against Obamacare for more than six years, the party could face a major backlash from its base if it stalls.
If the GOP wants to take rapid action, its best bet is to stick close to the playbook it used to pass a 2015 repeal bill that Obama vetoed. That measure included a two-year delay, and it cleared many of the parliamentary hurdles and whip counting required to pass major pieces of legislation.
“That stuff was all vetted,” said South Dakota Sen. John Thune , the chamber’s No. 3 Republican leader. “The repeal piece will be very similar.”
House conservatives are largely on the same page on repeal.
“When you look at how long it took with the insurance companies and the health care industry to re-engineer for all the changes that came out of Obamacare, you need to give them a couple years,” said Republican Study Committee Chairman Bill Flores of Texas, defending a two-year repeal delay.
Replacement is the far tougher task. The replacement plan is likely to be brand new, using principles laid out in Ryan’s “better way” agenda as a guide, sources said. Republicans have largely coalesced around Ryan’s plan, but there are still outstanding and controversial policy details to be ironed out, such as how — or if — people should get assistance to buy insurance.
Senate Republicans are talking about avoiding a massive bill and moving the replacement legislation in chunks: One that tackles purchasing insurance over state lines; another that deals with pre-existing conditions; another establishing new insurance plans for small businesses. That would take a long time and could bog down the process, but GOP leaders are eager to avoid the appearance of jamming a huge bill through Congress after criticizing Democrats for doing the same.
“We’re not going to pass another 2000-page bill like the Democrats have,” Cornyn said. “The way to realistically address this is to go step by step, to build consensus, get 60 votes and pass those various pieces.”
Gathering those 60 votes will prove difficult, so the GOP hopes the transition period and end-date on Obamacare will also give Republican lawmakers leverage with Democrats by forcing them to come off the sidelines and participate in rebuilding the health care system, even after opposing GOP efforts to tear it apart.
“The blame will fall on the people who didn’t want to do anything,” McCarthy said, foreshadowing a likely GOP talking point should Democrats block a replacement plan.
But Democrats said the GOP plan to put the onus on the minority party won’t work.
“They break it, they buy it,” said Sen. Patty Murray (D-Wash.), a Democratic leader.
The time frame leaders choose will undoubtedly affect their leverage with Senate Democrats. Ten Senate Democrats in red or purple states that went for Donald Trump are up for reelection in 2018. The pressure on those Democrats to negotiate could increase if chaos from the expiring Obamacare system occurs just as they’re trying to keep their seats.
“You might have one line of thinking to at least go along with the Republicans to see where you can work together with some fixes,” said Sen. John McCain (R-Ariz.)
If Republicans choose to wait until 2019 or 2020, however, they could find themselves with a larger majority, picking up seats in the 2018 election — though it’s not likely they’d win the nine needed to get to 60 votes and avoid having to work with Democrats.
Jennifer Haberkorn contributed to this report.