Congressional Republicans on Friday began an ambitious, weeks-long drive to produce an historic measure that will both repeal the nation’s massive health insurance law and replace significant parts of it.
It’s a goal fraught with risk for the GOP, and one that not even all Republican lawmakers are sure will succeed. Republicans promised voters to rid the country of Obamacare and replace it quickly, but internal GOP divisions surfaced Friday, the day Congress passed the legislative vehicle for repealing the law.
Nine Republicans voted against the bill, including second-term Rep. Tom MacArthur, of New Jersey.
“We have to fix healthcare in this country,” MacArthur said. “I just want to get it right. Sometimes right is not in a hurry. I voted no because I think we are going too fast and I want to know what both repeal and replace look like before we started the process.”
Congressional Republicans are being hurried along by the incoming Trump administration, which is calling on lawmakers to repeal and replace the law quickly and concurrently. That’s forced the GOP to pivot from its original plan to repeal the law leaving a transition period of years that would allow replacement measures to be passed over a much longer time frame.
Republicans are now hoping to accomplish in a matter of weeks some of what took Democrats many months: taking healthcare reform ideas and turning them into provisions that can win the approval of Republicans in both the House and Senate.
Lawmakers hope to include as many replacement provisions as possible within the repeal measure because it will be considered under budgetary rules that will prevent a Democratic filibuster.
But it’s not clear how much replacement legislation can be included in the repeal measure due to strict guidelines governing the use of the budgetary tool, known as reconciliation. The rule prohibits language and provisions that do not directly relate to the budget.
House Speaker Paul Ryan, R-Wis., said in the coming weeks that the process will be handed over to three House committees that will write the legislation and prepare it for a floor vote. The GOP-run Senate will write its own version of the repeal/replace measure.
With little or no Democratic support expected, the final measure will have to win over nearly every Senate Republican and all but 23 House Republicans in order to pass.
Not much will happen on healthcare next week. The House is out of session most of the week in preparation for Friday’s inauguration.
Instead, much of the conversation is expected to happen the following week in Philadelphia, when Republicans in both the House and Senate will meet for a joint retreat and “have a full, exhausting conversation,” Ryan said.
“Our goal is a truly patient-centered system,” Ryan said.
Expanding health savings accounts is among the proposals that will likely be part of the replacement plan. The repeal will extinguish Obamacare’s mandate and accompanying tax penalty as well as the medical device tax, GOP lawmakers said.
Republicans have also proposed replacing the law’s federal Medicaid expansion with less expensive block grants that would give states control of the spending.
Ryan has refused to set a specific deadline for when the House will complete a measure. But Trump wants the legislation on his desk in February, said House Ways and Means Committee Chairman Kevin Brady, R-Texas.
“My understanding is that his hope to have it to him in that month,” Brady told the Hugh Hewitt show last week. “That’s the timetable we’re working under.”
Rep. Dave Reichert, R-Wash., said Republicans are well prepared to swiftly turn their proposals into legislation.
“We’ve been working on this for a while,” Reichert told the Washington Examiner. “People say there are no plans, but there are plenty of plans. Once we move forward I think the country will become a little more comfortable as to where we are headed.”
