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Life Health > Health Insurance

Trump is big unknown on ACA repeal at GOP retreat

By Billy House

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(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.

Related: Trump may end ACA insurance requirement, Conway says

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John Thune, said he hopes House and Senate Republicans can settle this week on a path to replacing Obamacare once it’s repealed.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.

Related: Republican insurance commissioner proposes ACA patch

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.

House-Senate splits

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.

Missed target

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.

House Majority Whip Steve Scalise said late Tuesday that Republicans do have some areas of consensus already.

“Committees are going to be working through the details, but we want to start by rolling back the mandates so that people can actually sell products that families can afford and want without $12,000 deductibles and limited options,” he said. “There are a lot of things we already agree on: associations and small business groups pulling together to have buying power, health savings accounts, buying across state lines, medical liability — there are a lot of really good ideas that will help create real competition at a lower cost for families.”

More broadly, House Speaker Paul Ryan said Tuesday that Republicans aim to show that their unified control of the Senate, House and White House reflects “a bold government, a government of action,” not a timid one.

Corporate sponsors

This year’s “Congress of Tomorrow Issues Conference” is actually the latest rendition of what has been an annual event sponsored and partly financed by the Alexandria, Virginia-based Congressional Institute. The non-­profit relies on contributions from corporate and trade-association members.

House Democrats will hold their own retreat in early February in Baltimore, but they turn to taxpayers to foot much of their event’s bills.

Trump will add his voice Thursday to the retreat, which is to be blanketed all three days with tight security. Vice President Mike Pence and May, the British prime minister, are also to speak to the lawmakers on Thursday. Otherwise, news coverage of the retreat will be limited.

Ryan and Senate Majority Leader Mitch McConnell will kick things off shortly after the opening lunch Wednesday with a talk on “the 200 Day Plan,” according to an agenda obtained by Bloomberg. They will do so after a lunch and keynote address by Arthur Brooks, who runs the conservative American Enterprise Institute.

Pence and Peyton Manning

Pence will make his first appearance later Wednesday with a dinner visit and talk, to be followed by Simon Sinek, author of “Starting With Why” and “Leaders Eat Last.” Later in the night, pollster Frank Luntz will provide a “fireside chat.”

Other prominent outside speakers include two-time Super Bowl champion quarterback Peyton Manning and Ronna McDaniel, the new chairwoman of the Republican National Committee, at a Thursday dinner. Retired Army Major Scott Smiley, a wounded Iraqi War veteran and Ironman triathlete, will be the guest speaker at a Friday breakfast.

“I’m excited about the retreat,” said Brady, the chairman of the tax-code writing House Ways and Means Committee.

Brady and others said the final content of a tax-overhaul plan or timetable for its release might not be decided in Philadelphia. But Brady said the meeting gives House Republicans a chance to hold important in-depth talks with Senate Republicans and focus “on those shared goals.”

Ryan had begun earlier this week to use the phrase “200-day agenda” to refer to what Republican lawmakers hope to get accomplished by their August break.

Rep. Chris Collins of New York — an early Trump backer — said he expects discussion on that theme during the retreat. Along with efforts on tax overhaul and health care, Ryan reminded members Tuesday that a spring budget will be part of that 200-day agenda, and inside that document will be a fiscal path to accomplishing an infrastructure bill.

Related:

Collins: Where’s the ACA group plan enrollment data?

Brady to take over as head of U.S. House tax-writing panel

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