Vowing To Jettison Obamacare, Republicans Face Immediate Resistance And Risks

Speaker of the House Paul Ryan swears in the newly elected members of the House of Representatives during the opening of the 115th US Congress on Capitol Hill in Washington, D.C., on Tuesday. (Jim Watson/AFP/Getty Images)

The 115th Congress started work Tuesday with Republican majorities in both the House and Senate in agreement on their top priority 鈥斅爐o repeal and replace the 2010 health law, the Affordable Care Act.

鈥淭he Obamacare experience has proven it鈥檚 a failure,鈥 House Majority Leader Kevin McCarthy, R-Calif., told reporters at an opening day news conference.

But that may be where the agreement among Republicans ends. Nearly seven years after its passage, Republicans still have no consensus on how to repeal and replace the measure.

鈥淚t is risky business,鈥 said Thomas Miller, a conservative economist and former Capitol Hill aide now at the American Enterprise Institute.

Republicans, he said at a recent AEI forum, are 鈥渧ery good at fire, aim, ready.鈥 But with more than 20 million Americans getting coverage under the law, GOP lawmakers will have to tread carefully, Miller warned. 鈥淭he hard one is when you鈥檙e trying to defuse what鈥檚 already been out there, cutting the wires on the bombs sequentially鈥 so as to avoid a messy and destructive explosion.

Republicans are reportedly discussing a range of options for disassembling Obamacare, but analysts who have been involved in the intricacies of health policy for decades warn no replacement strategy will be easy.

The most immediate problem for the GOP is that even with majorities in both chambers of Congress, they do not have the 60 votes needed to overcome Democrats鈥 objections in the Senate. (There are 52 Republicans in the Senate now.) That means they won鈥檛 be able to pass a full repeal of the law on their own, and it is unlikely eight Democrats would join to overturn President Barack Obama鈥檚 signature legislation.

Even if they did have the votes standing by, they don鈥檛 have anything teed up to replace the health law.

鈥淚t鈥檚 not that Republicans don鈥檛 have replace bills. They have a couple dozen,鈥 said Douglas Badger, who oversaw health policy in the White House for President George W. Bush and worked for the Senate GOP leadership prior to that. 鈥淭he problem is they don鈥檛 have consensus,鈥 he said at the AEI forum.

Still, doing nothing, or even waiting, is not an option given that these lawmakers have been vowing to repeal the law almost since the day it passed in 2010.

鈥淵ou have to pass something,鈥 said Miller, 鈥渁nd whatever you pass you call repeal.鈥

The leading option under consideration is 鈥渞epeal and delay.鈥 The idea is to use the to overturn the tax-and-spending parts of the law, but delaying the effective date to buy time for Republicans to agree on a replacement bill.

But there are problems with that strategy. One is political 鈥斅燚emocrats are already crying foul.

鈥淚t鈥檚 not acceptable to repeal the law, throw our health care system into chaos and then leave the hard work for another day,鈥 incoming Senate Minority Leader Charles Schumer, D-N.Y., said Tuesday.

Added Sen. Richard Durbin, D-Ill., 鈥渋t鈥檚 not repeal and delay, it鈥檚 repeal and retreat.鈥

The plan also has raised concerns in the health industry. The goal of delaying the repeal date is to let people who have obtained insurance under the health law keep it while a replacement is formulated. But that is by no means guaranteed.

Insurance analysts have said that any more uncertainty in an already fragile marketplace could easily prompt insurers to , which would put at risk coverage for not just the roughly 10 million people who are purchasing plans there under the health law, but also the roughly 10 million people who previously had individual policies. (Another 10 million people have gained coverage under the health law through an expanded Medicaid program for those with low incomes.)

Without specific help for insurers from Congress, which would likely include insurance payments , 鈥渢he market will begin to crumble鈥 quickly, said Robert Reischauer, former president of the Urban Institute.

House Majority Leader McCarthy told reporters Tuesday that 鈥渘o decisions have been made yet鈥 on how Republicans might want to help stabilize the insurance market while they seek a replacement plan.

The individual insurance market could also be rattled if the incoming Trump administration brought by congressional Republicans who argued that the Obama administration was illegally using money to pay insurers to subsidize health costs for some low-income customers buying individual plans on the health law鈥檚 marketplaces. If the new administration bows out of the suit and those subsidies, insurers would not get reimbursed for the expenses, and some analysts predict it could force companies to leave the market.

On the other hand, attempting to repeal and replace the law in a single bill also could pose problems.

Repealing and replacing together 鈥渓ooks less like repealing than fixing,鈥 said Badger. 鈥淭hat could cause some angst鈥 among the GOP base that wants Obamacare to be fully eliminated.

And Democrats point out that Republicans are equally guilty of overpromising the benefits of overhauling the health care system, albeit in a very different way.

The goals currently being talked about by Republicans 鈥斅爄ncluding making health care more affordable, covering more people, reducing government spending and giving states more flexibility 鈥斅犫渁re impossible to achieve,鈥 within acceptable GOP budget limits, said Reischauer at the AEI event. 鈥淭here are going to have to be some tradeoffs,鈥 he said, as Democrats found when they tried to accomplish roughly those same goals.

Related Topics

InsuranceAffordable Care ActU.S. CongressRepeal And Replace Watch

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