In it, but not of it. TPM DC
With Trump in the White House, dismantling major aspects of the Affordable Care Act isn’t so hard of a legislative maneuver for Republicans. In fact, it’s one they even practiced less than a year ago, through a legislative move called reconciliation that was passed out of Congress but ultimately vetoed by President Obama. Reconciliation measures require only 50 votes in the Senate, rather than the 60 needed to overcome a presumed Democratic filibuster. But as a political and policy maneuver, repeal and replace is a heavy lift that the GOP hasn't had to fully confront until now.
A key question for lawmakers is whether they’ll go repeal Obamacare immediately, even before Trump's inauguration, or will they wait until they have a replacement plan queued up, which could take months or even years to pull together.
“That’s a legitimate discussion and an important one,” Sen. Roy Blunt (R-MO) said, when asked by TPM about the choice. He is chair of the Appropriations subcommittee that handles the funding for the Department of Health and Human Services' aspects of the ACA.
“I think a lot of smaller conversations are going on right now about, how do we do this so that we don’t hurt families, who have been hurt by Obamacare, once again by thoughtlessly moving without what comes next in mind. And we’ll see,” he said.
Sen. Tim Scott (R-SC) said it was his “personal opinion” that the two should happen simultaneously, but added, “I don’t know the direction of the caucus.”
“We have not actually said which way we would want to go. I would assume the repeal and the replace would come together,” he said.
Repealing Obamacare before a replacement is ready could have real world consequences and political fallout for Republicans as millions of Americans stand to lose their insurance if the Medicaid expansion is rolled back or if the individual marketplaces are dismantled.
Sen. Lamar Alexander (R-TN), the chairman of the HELP committee, said Thursday that a complete repeal and replace of Obamacare could take years.
"Eventually, we'll need 60 votes to complete the process of replacing Obamacare and repealing it because Obamacare was not passed by reconciliation it was passed by 60 votes. And it was cleaned up by reconciliation because Scott Brown won his election," Alexander said. "Before the process is over, we'll need a consensus to complete it, and I imagine this will take several years to completely make that sort of transition to make sure we do no harm, create a good health care system that everyone has access to and that we repeal the parts of Obamacare that need to be repealed."
That is something that many Republicans warn is a major factor in how they tackle the next few months.
“I would get rid of Obamacare any way I can, but I think we also have to have a methodology of care for people without Obamacare so I would be working to make sure we take care of [them],” Sen. Orrin Hatch (R-UT) said. Hatch has offered a replacement plan, but his, like the others floating around, has yet to have received consensus support.
He added Thursday that he didn’t think that anyone wanted to repeal it without replacing it, but “we'd have to look at the time."
Waiting to repeal Obamacare until a replacement is ready could enflame the GOP’s conservative wing. Another option that has been floated is to repeal it right away but with an effective date a year or two down the road to give lawmakers time to hammer out the replacement.
“It’s my own opinion that we should make a decisive move to repeal promptly with a trigger date so that all of us are motivated to come up with the best possible replacement plan,” said Rep. Trent Franks (R-AZ), who is a member of the group of hardliners known as the House Freedom Caucus.
House Budget Chairman Tom Price (R-GA) told reporters that nothing had been decided yet, but that they are basing the process on the reconciliation bill they passed previously that was vetoed by President Obama.
“It hasn’t been decided, but we’re working on what the logistics of that would look like and I think many of you know we have talked about about trying to do an FY 17 budget resolution that includes reconciliation instructions so we can move forward rapidly after the first of the year,” Price said. He added that it “hadn’t been decided, but that first phase would likely be for Obamacare.”
But other Republicans weren’t even willing to engage in the basic question of when and how exactly to repeal it.
Sen. Richard Shelby (R-AL) suggested that TPM “better talk to McConnell or Trump” when asked whether a repeal vote should wait for when there is a replacement plan ready.
“You’re really asking the wrong people here,” Sen. Jim Inhofe (R-OK) told TPM when asked the same question. “Because it’s the president who is going to be very much involved in that.”