It’s been two years since then-House Majority Leader Eric Cantor promised that Republicans would come up with an Obamacare replacement. Now, newly elected House Speaker Paul Ryan is making the same vow, but it might actually happen this time around.
As he prepares to lead his first GOP retreat this week, Ryan has asked members to bring a variety of policy ideas, including suggestions for how to finally construct an Obamacare alternative the party can rally around. The Wednesday vote paved the way for Republicans to pass their own healthcare reform, he said.
“Most importantly, it clears the path to repealing this law with a Republican president in 2017 and replacing it with a truly patient-centered health care system,” Ryan said.
Ryan said even though Obama would never sign the legislation repealing the health care law, the move put the GOP in a place to come up with an alternative. “This is where we truly kick off making this year the year of ideas,” Ryan said.
It’s a tough job for Republicans, as they have failed to present a comprehensive alternative since the 2010 Affordable Care Act was passed. But now they’ve got something new going for them, with Ryan in the driver’s seat.
Long one of the GOP’s most vocal advocates for presenting voters with concrete health policy ideas, the new speaker brings to his job a record of pushing for reforms with teeth behind them.
While serving as chairman of the House Budget Committee, Ryan engineered a plan to reform Medicare and managed to get one Democrat, Sen. Ron Wyden of Oregon, on board.
And while the country was awaiting a decision from the Supreme Court last year in the closely watched King v. Burwell case on Obamacare, Ryan was among a trio of House Republicans that outlined what they would like to replace Obamacare’s subsidies with should the court strike down most of them.
Ryan has charged House Energy and Commerce Chairman Fred Upton, R-Mich., and a few other lawmakers with working toward a plan. And leaders of the GOP Doctors Caucus said Wednesday that they’re working on their own Obamacare replacement bill in the coming weeks, one that will combine a proposal from Rep. Tom Price, R-Ga., with the plan put forth by the Republican Study Committee.
Add to those efforts a slew of conservative healthcare proposals over the past two years from Republican presidential candidates and lawmakers, and the GOP has a plethora of ideas to choose from.
Ryan is not holding the House to actually passing a bill, instead saying the important thing is to present an Obamacare replacement plan to voters as an example of what the party would do if it wins big in November.
Ryan spokeswoman AshLee Strong told the Washington Examiner that the intention of the retreat is to “solicit and discuss ideas for the year on this topic and other agenda items.”
Aides and lobbyists say there has been no real coalescing around a single set of ideas. But some are optimistic that Republicans can come up with their first-ever Obamacare replacement plan, now that they have figured out a way to repeal most parts of the law using special budget reconciliation rules.
House Democrats didn’t have a health reform plan when Obama was elected president in 2008 and it took them six months to produce a bill, one House Republican aide noted. The aide cited a “a notable evolution” in GOP healthcare policy, advanced by lawmakers and candidates who have presented their own Obamacare alternatives.
But the challenges are many. Republicans are divided on how to treat low-income people who don’t qualify for Medicaid under the pre-Obamacare rules but struggle to afford health insurance.
Most plans would provide tax credits to them, but they vary as to whether they would be available to those who pay no taxes at all (known as “refundable”) and whether they would be pegged to the recipient’s age, the average tax benefit for employer-sponsored coverage or something else.
In an op-ed in the spring laying out an “off-ramp” to Obamacare, Ryan called for a refundable tax credit that is also “advanceable” so people could get it when they needed it. The credit would be based on a person’s age.
That op-ed also laid out other clues as to what kind of reforms Ryan might push for in a replacement bill. He called for allowing plans to be sold across state lines, enacting medical liability reforms and letting small businesses band together to buy insurance.
At the same time, Republicans probably will want to allow their presidential nominee to lead the discussion on how to replace Obamacare. Jeb Bush and Ben Carson are the only Republicans in the presidential race who have proposed alternatives, although Scott Walker and Bobby Jindal, who have dropped out, also did so.
“I can’t imagine it would be anything other than what folks have already discussed since the presidential candidates want to drive that debate,” said one GOP lobbyist.
