Republican leaders gathered Friday morning with Secretary of Health and Human Services Tom Price to assure the press and the public that despite reports of defections, divisions, and disagreements in the party, the plan to repeal the Affordable Care Act is advancing smoothly.
“Republicans are united,” Rep. Cathy McMorris-Rogers (R-WA) insisted even as more lawmakers and Republican governors come out against the legislation.
At the Friday press conference, the GOP leaders and Health Secretary continued to push an argument that emerged over the course of this week as the bill has become mired in criticism—particularly after the Congressional Budget Office reported that the bill would trigger massive insurance coverage losses. The legislation shouldn’t be judged in isolation, they said, because it’s part of a “three-phase process.”
“This plan is in three phases,” Price told reporters. “The reconciliation bill, the kinds of things we’re able to do at the Department, and more legislation with an overall plan to move us in the direction of patient-centered health care.”
Regarding the administrative actions in “phase two,” Price noted that Obamacare left a lot of room for executive branch decision-making, and he plans to take full advantage of that while Congress works to repeal the legislation.
“There are 1,442 citations in [the Affordable Care Act] where it says ‘The Secretary shall’ or ‘the Secretary may,'” he said. “The previous administration used that fairly well. So we’re going to look at every single one of those areas and ask the question, ‘Does this help patients or does this harm patients? If it harms patients, we’re going to modify it or get rid of it. Does it increase costs or decrease costs?”
The proposed “phase three,” meanwhile, involves passing health care industry reforms through regular order legislation that would require 60 votes—meaning Democrats as well as Republicans—in the Senate.
Some Republicans in the House and Senate are deriding both these “phases” as impossible, saying the current bill up for debate is the party’s one chance to overhaul the nation’s health care system.
“It’s a total fantasy,” Rep. Raul Labrador (R-ID), a prominent member of the House Freedom Caucus, told reporters on Thursday. “Steps two and three are not going to work. Step two requires us to believe that Tom Price is going to go and do something that is outside of the law. If you remember, we were all opposed to President Obama doing something on immigration that went outside of the law, and the courts stopped him. So how in the world is Tom Price going to go outside of the law and stop Essential Health Benefits?”
(Essential Health Benefits are the 10 areas of coverage insurers must provide under the Affordable Care Act. Conservatives want gut this regulation to allow for the sale of cheaper and skimpier plans.)
Labrador was similarly skeptical of promises of additional legislation that could garner 60 Senate votes.
“Step three requires us to believe that the left is going to join us in voting for things that will repeal and replace Obamacare,” he said. “It’s a fiction. The only chance we have is step one.”
Other Freedom Caucus members expressed serious doubts about the prospect of future “phases” of health care reform.
“Let’s just say that I’m skeptical,” Rep. Joe Barton (R-TX) told reporters on Friday. “Obviously we know phase one is for real. And I accept the President and his advisors at face value regarding phase two’s executive orders and administrative actions. But this phase three is a little bit more problematic, unless the you can convince eight Democrats or make the Senate change its 60-vote requirement. Now there are some Democrats up for reelection in Trump states next year, so anything is possible. If their constituents demand they support this, maybe they will.”
Over on the Senate side, some lawmakers are sounding the same alarm.
Sen. Tom Cotton (R-AR) echoed Labrador’s concerns, arguing that Price’s administrative actions could be “subject to court challenge,” and that it would be foolish to hope for “some mythical legislation in the future that is going to garner Democratic support.”
He dismissed the entire three phase plan as “just political talk” to convince wavering members to fall in line and vote for the current bill.
“That’s why it’s so important that we get this legislation right, because there is no step three. And step two is not completely under our control,” he told conservative radio host Hugh Hewitt.
Sen. Ted Cruz (R-TX), a critic of the “phase one” bill, has also thrown cold water on the idea of the subsequent phases.
“Anything placed in so-called bucket three will never pass,” he said. “If we want to pass real reforms we have to do it now on budget reconciliation.”
Still, many Republican lawmakers were willing to repeat leaders’ three-phase narrative Friday morning, though like Price they gave few concrete details on what the yet-to-be-revealed phases entail.
“This is the first phase,” stressed Rep. Pat Tiberi (R-OH).
“This is the first step of a long and complex process,” said Rep. Drew Ferguson (R-GA).
Rep. Tim Murphy (R-PA), the only psychologist serving in Congress, told TPM that he hopes phases two and three will address the nation’s mental health crisis.
“We can come up with some bipartisan solutions, basically the same things Democrats voted for before, I’m assuming we can put those in and they’ll support them again,” he said.