Congressional Republicans are torn between their desire to quickly deliver on their campaign promise to repeal the Affordable Care Act and their fear of botching the alternative by drafting and passing it too hastily.
“We can’t screw it up like the Democrats did, so we’ve got to be very careful,” Rep. Chris Collins, R-N.Y., said Tuesday.
House Speaker Paul Ryan, R-Wis., promised swift action Tuesday but did not commit to “repeal and replace” all at once.
“So without delay, we are taking action,” Ryan said. “We are putting in place the tools necessary to keep our promise on this law.”
Those “tools” are looking like an at least three-step process: a budget resolution instructing committees to write legislation that would actually repeal the healthcare law and substitute it; budget reconciliation enacting repeal and some popular replacement ideas; and one or more bills dealing with the law’s most complex components, such as its tax implications.
The idea is to show voters quick action while giving lawmakers the breathing room to draft — and agree upon — a complete replacement plan.
“You can’t repeal it and replace it quickly; that’s an oxymoron,” said, Collins, and early Trump supporter who is close to the president-elect and the transition. “We can repeal it quickly. And we replace it in a timely fashion.”
The most likely timetable looks like both Senate and House passage of the budget this week, followed by reconciliation next month and a complete package a year or more down the road.
“It won’t be two years and it won’t be two weeks,” Collins said. “It’s just the definition of ‘quickly.'”
Collins said he would like to complete everything in six months.
Republican pollster and consultant David Winston said it’s OK if the new system doesn’t kick in immediately and if Republicans opt to phase out Obamacare.
“Yes there’s a need for tempo; but there’s also a need to make it right,” Winston said. “This is not a small piece of legislation.”
Winston, Collins and some other Republicans admit — despite claims from Ryan and other leaders that they have ready-to-go legislation in their “better way” plan rolled out last summer — that the GOP was not ready to drop a bill the day the 115th Congress gaveled in.
The 65 times House Republicans voted during President Obama’s tenure to repeal the ACA, they weren’t ready to replace it, Collins admitted.
“Everybody knew that whatever we did would ultimately be vetoed by him anyway so, call them messaging bills,” he conceded. “Well now we have all the levers. We need to send this president a bill that’s going to get signed into law…so we got to be very careful.”
Democratic lobbyist Jim Manley, a former long-time Senate Democratic leadership aide, said Republicans are treading on treacherous ground.
“I can’t think of anything more dangerous of repealing it while delaying the replacement for two-to-three years,” he said. “No reputable economist on either side of the aisle thinks that that’s workable. They are going to rue the day they did this if they go done that path.”
Sen. Lamar Alexander, R-Tenn., said that a staggered timeline is fine as long as final repeal happens only after every ACA component is addressed.
“To me, ‘simultaneously’ and ‘concurrently’ mean Obamacare should be finally repealed only when there are concrete, practical reforms in place that give Americans access to truly affordable healthcare,” the Senate Health, Education, Labor and Pensions Committee chairman stated Tuesday. “The American people deserve health care reform that’s done in the right way, for the right reasons, in the right amount of time. It’s not about developing a quick fix. It’s about working toward long-term solutions that work for everyone.”
Republicans most often discuss including provisions to retain the ACA’s most popular features in repeal legislation. Those include improving Health Savings Accounts, forbidding insurers from denying coverage to patients with pre-existing conditions and allowing adult children up to age 26 to remain on their parents’ policies.
The harder issues whose solutions could take more than a year to find include the employer mandate, the medical device tax and the Medicaid expansion.
So everybody wants the answers, but really, there’s no answers,” Collins said.
“For instance, how does a low-income individual…access what you would call ‘good, affordable’ insurance?” Collins asked. “We’re going to have to do deal with that.”
And not everyone is willing to give committees a year or more to come up with the answers.
Most notably House Freedom Caucus members and Sen. Rand Paul, R-Ky., don’t want to give Congress a chance to procrastinate. They want to simultaneously repeal and replace, or at least get a commitment from leadership for a tight turn-around.
“We do have members who feel if we don’t do them together, the replacement plan may never happen,” acknowledged Collins, President-elect Trump’s closest Hill ally.
