(Bloomberg) — Key Republicans in Congress are cautioning that replacing the Affordable Care Act will be a difficult and lengthy process that won’t happen in the first days of President-elect Donald Trump’s administration.
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U.S. Senator Lamar Alexander, chairman of the Health, Education, Labor and Pensions Committee, said the health care law should be replaced in a “step-by-step” process to give states more control, which won’t be done quickly.
“I imagine this will take several years to completely make this transition,” Alexander, a Republican from Tennessee, told reporters in Washington Thursday. “We need to gradually move those decisions back to states and to individuals and do it in a way that does no harm to people today.”
The ACA took years to legislate and implement. Trump and Republicans have said they want to keep some parts of the law, like popular provisions guaranteeing coverage. They have yet to settle on other matters, though, like whether or how much financial support to give people. A repeal signed in Trump’s first days might not take effect right away — giving Republicans a lengthy period to try and write complex policy and avoid a sudden shock to the health-care system.
Repeal is the simple part, said Senate Finance Committee Chairman Orrin Hatch, a Utah Republican and key player in the health debate. Finding a replacement is harder.
“It’s not going to be an easy process, but I think Democrats and Republicans will work together to get a better system,” Hatch said to reporters in Washington on Wednesday.
Repeal and wait?
“It’s going to be harder than a lot of us think,” said Senator Lindsey Graham, a South Carolina Republican who opposed Trump’s run for president and has called for the ACA’s repeal and replacement.
Related: Ryan seeks to end ACA while keeping its most popular parts
Whatever Republicans decide on may take years to implement. When a Republican-written repeal bill was sent to President Barack Obama in January, and vetoed, it included a two-year delay before kicking in. House Ways and Means Committee Chairman Kevin Brady, a Republican from Texas, said discussions are ongoing on repeal and replace, including on the idea of a built-in delay and what else would be in a bill.
“The answer is to be determined,” Brady told reporters this week.
Health insurers are waiting to see what Republicans propose, and urging Trump and the Republican Congress not to disrupt the health-care system further.
“At the moment, our message is, ‘Let’s be thoughtful,’” said Ceci Connolly, chief executive officer of the Alliance of Community Health Plans, which lobbies on behalf of regional and state-based insurers. “Let’s not disrupt millions of people.”
Republicans could keep those provisions they favor, like guaranteeing coverage for pre-existing conditions, and eliminate one they strongly oppose, the “individual mandate” — a requirement that all Americans purchase health coverage or face a financial penalty.