Conservatives are getting antsy on Obamacare repeal

House Speaker Paul Ryan insisted this week that the repeal-and-replace effort is on track, telling lawmakers that that plan is to mark up a measure in committee next month. But as Congress prepares to depart for a weeklong recess, no final decisions have been made about how to handle the stickiest problems of repealing and replacing the Affordable Care Act.

And multiple Capitol Hill meetings this week among legislative staff, members themselves and even Vice President Mike Pence yielded few new details about what a final plan will look like or whether enough members will get on board to pass it.

“There’s a number of different thoughts that are going out,” said Rep. Fred Upton, R-Mich., former chairman of the Energy and Commerce Committee.

Asked whether he’s certain there will be a plan in the next few weeks, Upton paused. “I think so, stay tuned,” he said.

Leadership and committee staff have been sending elements of a plan to the Congressional Budget Office for scoring, drawing mainly from the speaker’s own healthcare proposal.

They’re expecting to get some initial feedback on Friday, giving them a guidepost for how to tweak the plan to make it cover more people or cost less, lobbyists say.

But conservatives are getting impatient with that timeline, dialing up pressure on GOP leadership to hold a repeal vote right away, before a replacement plan is ready. On Wednesday, members of the House Freedom Caucus joined Sen. Rand Paul to lay out a set of recommendations for how the law should be replaced.

They stress that they want a replacement to the healthcare law that includes tax-free health savings accounts, a tax deduction for buying coverage and access to healthcare associations for people without employer-sponsored coverage. But above all, they want to vote on repealing Obamacare.

“We were tired of waiting, and that’s why we took the position of ‘let’s go and let’s go now,'” said Rep. Jim Jordan, R-Ohio.

It’s been five weeks since the House and Senate voted on a budget reconciliation bill being used to repeal much of the 2010 Affordable Care Act. Republicans had aimed to act speedily to get legislative text ready—and President Trump had promised a quick repeal vote—but the timeline has lengthened as members have struggled to achieve consensus.

Yet pressure is building for Congress to act quickly, before insurers have to set 2018 rates and before a continuing resolution funding the government expires on April 28. Republicans who won their seats partly on promising to repeal the law say they need to follow through without further delays.

“We owe this to the conservatives around the country who voted for us to repeal it,” Paul said.

There are a few basic health reform ideas that unify most Republicans. They want to repeal the healthcare law’s mandates to have coverage and its taxes. They want to expand the use of tax-free savings accounts. They want to do something different with the law’s Medicaid expansion and its subsidies for buying private coverage.

But Republicans expressed disagreements over how to structure it all, particularly the law’s subsidies, in meetings this week. At a Wednesday morning meeting, House legislative staff raised concerns about how to encourage healthy young people to sign up for coverage without the individual mandate.

Scalise also held meetings with members on Tuesday to discuss Medicaid reforms and changes to the law’s subsidies. Another meeting, this one on tax-free health savings accounts, is scheduled for Thursday afternoon. House Republicans also say they plan to discuss repeal-and-replace at their conference meeting Thursday morning.

Senate Republicans discussed Obamacare repeal and replace with Pence and with Health and Human Services Secretary Tom Price, but didn’t emerge with many definites, either.

“We really talked in generality, he answered a lot of questions, invited us all to participate and all of us have a lot of different ideas, but I think that it’s beginning to gel,” said Sen. Mike Rounds, R-S.D., after meeting with Pence.

In an interview Wednesday with the Washington Examiner, Senate Majority Leader Mitch McConnell called the repeal and replace effort “complicated” and “hard.”

He pointed to administrative changes to the law that Price can make without any help from Congress. Earlier in the day, the administration had released a 71-page rule to tighten up the law’s enrollment rules.

“Under the law, the secretary has a lot of latitude,” McConnell said. “It’s now going to be used to help get us to a better place rather than being used to produce the current nightmare.”