GOP Obamacare summit yields no new details on repeal strategy

(Bloomberg) — Congressional Republicans emerged from a retreat this week aimed at forging agreement on how to repeal and replace Obamacare with little new clarity on the details.

No precise plan has emerged because “we are still developing what this thing is going to look like,” Sen. Jim Risch of Idaho told reporters Thursday.

Republicans tried to put a happy face on their meetings, but they made little tangible progress. The chairman of the tax-writing House Ways and Means Committee, Kevin Brady of Texas, said “We’re just working really productively right now, so no timetable’s been set.”

President Donald Trump arrived to tell Republicans in person that “repealing and replacing Obamacare” was his top legislative priority, but several lawmakers were frustrated that the closed-door sessions provided no new specifics on the path to a repeal bill or the content of a replacement. That included the most anticipated session of the three-day policy retreat, titled “Keeping Our Promise On Health Care,” which was led by several House and Senate committee chairmen and Andrew Bremberg, a top White House official.

The word “Obamacare” could be used to refer to all of the Affordable Care Act package, parts of the package, or only the parts related to commercial health insurance and efforts to expand access to Medicaid.

Rep. Chris Collins of New York, an early Trump backer, insisted that Republicans are getting closer together.

“We got folks that want to go 60 miles an hour. We have folks that want to go 80 miles an hour. And some of these folks now want to go 100 miles an hour,” Collins said. “That’s our differences. But we’re all driving down the same road.”

Missed deadline

Republicans adopted a budget resolution earlier this month that set a target of Friday to deliver a repeal plan. But on Thursday, GOP leaders were signaling a shift to a slower, more careful pace in undoing and replacing President Barack Obama’s signature legislative achievement.

House Speaker Paul Ryan told reporters at the retreat in Philadelphia that Republicans could “make good” by August on devising aspects of the party’s health care promise and other top policies they campaigned on in 2016, such as a tax overhaul. But he also stopped short of promising completion of anything by August.

“We don’t want to set arbitrary deadlines on things,” he said. “We want to get things right. We want to get them done the right way. We want to move quickly, but we want to get things right.”

Senate Majority Leader Mitch McConnell said Ryan had laid out a “a game plan through the August recess of what we want to try and accomplish,” and that “I intend to stick to the plan and make as much progress as we can.”

As for Trump, he too offered no details in a speech to Republicans Thursday.

“It’s a disaster,” Trump said of Obamacare. He said he’d talked to Ryan and others about not doing anything for two years, as a way to get Democrats on board with adopting a new national health care plan. “But we have no choice. We want to get something done and get it done right,” he said.

The details are where Republicans are getting hung up. Risch said there isn’t any agreement yet, for instance, on one of the toughest topics: whether to keep Obamacare’s taxes and other revenue streams.

‘It’s incredibly complex’

Wisconsin Republican Sen. Ron Johnson said he’s long believed that fixing Obamacare is a complicated process and “we have to transition to a system that actually works. It’s incredibly complex.”

”Obamacare has caused a lot of damage, that’s our first priority, repair that damage,” he said.

In the closed-door Obamacare session, two lawmakers said their questions about potential ideas — and their costs — only prompted replies that those hadn’t been analyzed by congressional auditors.

Lamar Alexander of Tennessee, who chairs the Senate’s health panel, did tell fellow Republicans that the biggest challenge for Republicans to navigate in shifting from Obamacare to a new plan is the 4 percent of Americans who have obtained coverage on the exchanges.

Potential tax credit

But they couldn’t tell members yet what a potential tax credit in a Republican plan may look like; give specifics of the impact of any Medicaid expansion plan for the states; or discuss any antitrust implications for insurance carriers in a Republican plan. Leaders did say aspects like health savings accounts and assigned risk pools might be elements tackled in a reconciliation bill.

Next week, Congress will hold hearings on several major policy issues that need to be addressed in any repeal and replace scenario. Members of the House Energy and Commerce Committee will hold two hearings on strengthening Medicaid and prioritizing the most vulnerable in the federal-state shared health program for the poor. Many governors who expanded Medicaid under the ACA, including some Republicans, have made it a priority to protect those that could lose coverage under a repeal and defend the extra funds they’ve received for the program in their states.

That panel will also look at several bills that aim to lower younger consumers’ premiums by allowing insurers to charge older Americans more, ensure patients with pre-existing conditions aren’t denied coverage and tighten enrollment periods.

The Senate health committee also plans to hold a hearing on stabilizing the individual health insurance market, which tends to be the focus of Obamacare criticism as insurers have dropped out of the market and premiums have risen.