House Republicans have nailed down a few key Obamacare repeal-and-replace priorities: Make health insurance affordable, be methodical in crafting a replacement and do it all quickly.
Senior House GOP aides stressed Thursday that President-elect Trump and congressional Republicans are firmly resolved to pass a bill repealing parts of the Affordable Care Act within the first 100 days of the new administration and immediately begin work on an alternative.
Aides also said Republicans are committed to using what is known as “regular order,” in which legislation is passed through committees instead of being crafted at the last minute behind closed doors.
They said they are going to prioritize ideas to reduce the overall costs of health insurance, rather than ensuring everyone in the U.S. buys it, which was a major goal of President Obama’s healthcare law. It’s OK if people decide not to buy coverage, as long as they could if they wanted to, aides said.
“It’s universal access,” a senior GOP aide said. “Our goal here is to make sure everybody can buy coverage or find coverage if they choose to.”
The House and Senate plan to compile a budget reconciliation bill early next year to repeal the Affordable Care Act but keep it going for an additional two to four years while lawmakers find a replacement. Trump wants to sign a repeal bill within the first few months of 2017, aides said.
But beyond those goals, how Trump and Republicans will replace the healthcare law is largely up in the air.
Aides wouldn’t put a timeline on exactly when Congress will have a replacement ready, saying only that their aim is to move “as fast as humanly possible.”
“I think we have an internal clock that says as soon as the committees have ideas, let’s start moving on them,” an aide said.
Lawmakers haven’t decided whether to pass one replacement bill, which could present major challenges in getting Democrats on board, or adopt a more piecemeal approach in which they advance reform measures individually.
Nor have Republicans decided exactly what will be in the repeal bill, although aides indicated it’s unlikely that they will try to add in more Affordable Care Act elements than were already contained in a repeal measure Congress passed earlier this year.
While Obama vetoed that bill, it was an exercise for Republicans in which parts of the healthcare law they could repeal using special budgeting rules. That maneuver allows them to buck Senate Democrats, passing the bill with a simple majority instead of the typical 60 votes.
Trump and Republicans face tough political questions as they approach Obamacare repeal. One of the most pressing concerns is how to prevent the individual insurance market from collapsing during the transition, as insurers face major uncertainty about who their customers will be in a post-Affordable Care Act era.
Millions of people stand to lose their health coverage if the law is repealed. Over the last few years, the law has dramatically expanded coverage through Medicaid expansion and new marketplaces where subsidized, private plans are sold.
Democratic leaders oppose efforts to repeal the healthcare law, although some in the party may be open to some of the GOP replacement ideas. Aides stressed that House Speaker Paul Ryan is committed to using the regular committee process to get as many members on board as possible.
“He’s very serious about public litigation of these issues, moving them through the committee process through regular order,” a senior GOP aide said.
