(Bloomberg) — Republicans are coalescing around a plan to quickly pass next year a delayed repeal of ”Obamacare” — the health care system created by the Affordable Care Act — to give them two or three years to craft an alternative.
But that plan, designed to create a “cliff” that according to lawmakers and aides would push Congress to get its act together, comes with significant perils.
“We’re going to begin immediately to repeal Obamacare and reconciliation is the only way to do it. And I believe we will have 51 Republican senators or 52 to vote for that,” Sen. Lamar Alexander of Tennessee, who chairs the health committee, told reporters Thursday.
Senate Majority Leader Mitch McConnell, who represents Kentucky, “has said it will be two or three years before the repeal takes effect,” Alexander said, urging his party to provide “clear signals” about a replacement plan before the vote.
Privately, Republicans are engaging in frantic efforts to find a way forward and fulfill that promise, now that they’ve won control of the White House and Congress. They’ve been unable to agree on a health care alternative ever since the 2010 law was enacted over their objections. GOP lawmakers and policy aides describe it as a top priority next year under President-elect Donald Trump.
After a closed-door meeting of House Republicans on Friday, Rep. Blake Farenthold of Texas said the earliest action on a repeal will probably come in February because of procedural rules.
“The idea is to repeal immediately, and act on a replacement as soon as possible,” he said. A replacement will require Democratic votes in the Senate and work has to be done with insurance companies, Farenthold said.
“Leadership doesn’t want to over-promise,” he said.
Sen. John Cornyn, the Republican majority whip, said he expects a repeal to move forward in the first 100 days of the Trump administration, even if the Senate is “jammed up” with confirmations of appointments by the new president.
But undoing President Barack Obama’s signature law is easier said than done. There are at least five major obstacles the GOP must overcome.
No party-wide consensus
Congressional Republicans have held dozens of votes to repeal or dismantle the 2010 law, but haven’t been able to push through a detailed replacement plan in either chamber. A scattershot of replacement proposals — including one from House Budget Chairman Tom Price, Trump’s pick to run the Department of Health and Human Services — have failed to gain traction within the party.
“It’ll take a while, and nobody should think that on day one we’re going to repeal and replace it,” said Republican Sen. Jeff Flake of Arizona.
One reason is that many Republicans are unable to agree on what to do about the estimated 22 million people who would stand to lose their health insurance, according to the nonpartisan Congressional Budget Office, if the law is repealed.
“I am of the view that we can’t pull the rug out from under people who have been, in many instances, forced into Obamacare,” said Sen. Jerry Moran of Kansas. “So this will take some time to make certain that we protect people and their health care.”
Ideologically, conservative opposition to regulations and spending creates a dilemma. Before Affordable Care Act rules took effect in January 2014, insurers could deny coverage to sicker Americans. And many Republicans oppose using taxpayer money to subsidize health care for the poor, which limits the options for extending coverage.
Popular pieces tied to unpopular ones
Republicans — including Trump and House Speaker Paul Ryan — say they want to keep popular components of the law, such as the coverage guarantee for people regardless of their medical history.
Sixty-nine percent of Americans support the pre-existing condition provision, including majorities of Republicans, Democrats and independents, according to a Kaiser Family Foundation poll released Thursday.
Yet only 35 percent support the individual mandate to buy insurance or pay a tax penalty.
That disconnect will be tough to reconcile. The mandate is seen by many health policy experts — as well as the insurance industry — as inextricable from the pre-existing conditions guarantee, as it increases participation of healthier people to defray the high costs of caring for sick customers.