(Bloomberg) — President Trump will be the star attraction at a three-day policy retreat Senate and House Republicans are kicking off Wednesday, where they are under pressure to bridge sharp divisions over how to devise a promised replacement for Obamacare.
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The agenda at the Philadelphia meeting includes public speeches by Trump and U.K. Prime Minister Theresa May, but most of the real action will occur behind closed doors as Republicans try to set a course forward on health care and, for later in the year, a tax overhaul. Both efforts are being complicated by the unpredictability of the new president, who has sent mixed signals on the strategy and content of a replace plan.
The Senate’s No. 3 Republican, South Dakota Sen. John Thune, said he hopes House and Senate Republicans can settle this week on a path to replacing Obamacare once it’s repealed.
“Consensus is something we are aiming for,” said Thune, chairman of the Senate Republican caucus, to reporters Tuesday. “The key is to find as much common ground as we can with regard to the substance and process, about how we proceed going forward.”
But sharp differences remain over such issues as the timing of repeal and replace, whether those would be done simultaneously or in some other way, and what parts of the ACA to retain, if any, including Affordable Care Act taxes and other ACA revenue streams.
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Trump has also made several promises, during the campaign and after winning the election, that have confounded many congressional Republicans, including that everyone covered under the ACA will have coverage under a replacement. That’s something the GOP has been reluctant to promise, given the potential cost.
Additionally, House and Senate Republicans are split on even basic approaches.
For instance, four Republican senators, led by Susan Collins of Maine and Bill Cassidy of Louisiana, offered a plan this week they say could attract Democratic support because it allows states that like Obamacare to keep it. States would have other options, as well. Lindsey Graham of South Carolina became the fifth Republican senator to back the plan, saying in a statement Wednesday that it “ensures those with pre-existing conditions can get coverage.”
But on Tuesday, Rep. Mark Meadows of North Carolina — a leader of a group of arch-conservatives in the House, the Freedom Caucus — panned the bill.
“I don’t see it as a workable solution,” said Meadows, who added that he appreciated the two senators for putting out a bill that helps start the process of finding a plan, but that, “it’s not as conservative as I’d like to see.”
There are also differences over how to carry out Trump’s call to block-grant Medicaid funding to the states, while also making sure those who received coverage under the ACA Medicaid expansion don’t lose it. Most recent House GOP budgets for the past few years have included a block-granting proposal. But many Senate Republicans prefer Medicaid funding to the states based on the number of people who qualify for it.
When Republicans adopted a budget resolution earlier this month that enables them to avoid a Senate filibuster on a repeal bill, they set a notional deadline of Friday to present a repeal plan, with the aim of getting it to Trump’s desk by Feb. 20.
But the repeal effort will almost certainly take longer. Trump has said he wants to wait for his Health and Human Services nominee Tom Price to be confirmed so that he can weigh in with the president’s preferred strategy. Price’s nomination is still pending.
One of the retreat’s panels on health care features Andrew Bremberg, the director of Trump’s Domestic Policy Council who led his transition team for HHS. He will speak alongside several of the lawmakers at the center of the Obamacare debate, including House Energy and Commerce Chairman Greg Walden and Lamar Alexander, who chairs the Senate’s health committee.