After GOP Confab, A Clear Path To Replace Obamacare Is Still Elusive

January 27, 2017 6:00 a.m.

PHILADELPHIA – After two days in Philadelphia, Republicans are still grappling with how to repeal and replace the Affordable Care Act, with no signs that they have reached a consensus or are ready to plow ahead with a specific plan.

Republicans have been promising for seven years that the Affordable Care Act would be repealed and replaced but at this moment, it appears they are still slogging through the details, and it’s frustrating members.

“It’s time that we start talking about specifics, negotiating back and forth on what works and doesn’t work for our constituency,” said Rep. Mark Meadows (R-NC), the chairman of the uber-conservative House Freedom Caucus, which has been pleading with leadership to provide more details about their Obamacare repeal and replace plans.

Noting his preference to vote on a replacement in the same Congress that they pass repeal, Meadows said, “There’s still a real push for a longer glide path of three to five years, depending on who you talk to, and so I don’t know if that is something that we will necessarily see happen, even though it’s a request.”

Republicans gathered Thursday morning specifically to discuss what should be in the reconciliation package to repeal Obamacare. Republicans voted to repeal Obamacare earlier this month, but now the hard work of outlining the parameters of that are in the committees’ hands, and Republicans say no consensus has emerged.

“I was encouraged. We had a constructive discussion. You rarely get the House and Senate Republicans in the room,” said Rep. Kevin Brady (R-TX), the House Ways and Means Chairman. “No decisions today … but very positive conversation.”

So far, what appears to have been settled is a timeline in which Republicans first pass a reconciliation bill that dismantles major parts of Obamacare, akin to the 2015 legislation vetoed by President Obama, but with a few additional “replace” elements — though there were few details of what those provisions would look like.

Republicans in Congress would then depend on the Health and Human Services secretary (nominee Rep. Tom Price, a Republican from Georgia, awaits Senate confirmation) to use administrative actions to change other pieces of Obamacare. But there were few details on that front, either, besides the fact that 1,400 administrative items have been identified as within Price’s power to change. After that, there would be other replacement bills considered in the regular order, to use Senate parlance, but because they would require 60 votes in the Senate, those would need Democrats to pass.

“There are pieces here that we can fix along the way, but there’s no single fix, there’s no single plan,” said Rep. Greg Walden (R-OR), the chairman of House Energy and Commerce Committee, one of the committees that will write the repeal legislation.

During the two-day retreat, members said that Senate Majority Leader Mitch McConnell (R-KY) emphasized that Senate Minority Leader Chuck Schumer (D-NY) was unlikely to play ball.

It appears there was not a yet a clear strategy for picking off Democrats for replacement provisions down the road.

“I’m not the whip,” said Rep. Michael Burgess (R-TX), who chairs the subcommittee on health under the House Energy and Commerce Committee, when asked how they would get Dem votes.

Members admitted that the they did not achieve a full consensus on their ideal Obamacare alternative, which leaders have said will be tackled in piecemeal fashion rather than one bill.

“It’s hard to get a coalescing when you’re in a big theater, and you’re talking and people are asking questions, it’s hard to tell,” said Rep. Steve Stivers (R-OH). “I think there’s been a lot of information exchange that’s been processed by a lot members, but it’s but hard to tell how that manifests itself.”

One major issue Republicans are trying to negotiate is whether Obamacare taxes should be repealed immediately or kept in place to fund Republicans’ own replacement plan down the road. Some Republicans vocally worry about the optics of keeping Obamacare taxes they railed against for years; others, however, worry taking them away may make it impossible to pay for a replacement.

Multiple members said that either no decision had made on whether to keep the taxes, or that they were deferring to Brady to make that announcement.

“I wouldn’t feel good about telling you there is agreement there yet,” said Sen. Jim Risch (R-ID), when asked if there was consensus on the issue of whether to repeal the Obamacare taxes immediately or down the road.

Another major issue facing Republicans is what to do about subsidies, known as cost-sharing reductions, that were paid to insurers under the Obama administration that are the target of a House GOP lawsuit. According Burgess, there was no communication to members about the next steps on the lawsuit — which if, successful, would prompt immediate chaos in the individual market.

“I don’t how hard it is going to be. I don’t know how politically difficult it is going to be,” Burgess said, of the prospect of continuing the subsidies. “But that is one of the tasks that is immediately in front of us.”

Congressional Republicans tried to tamp down panic about how slowly the process was moving noting that the Affordable Care Act was thousands of pages long that cannot be reversed overnight. But conservatives are anxious.

On Thursday, the Heritage Foundation published an op-ed titled “Congressional Delay Threatens Obamacare Repeal” arguing that Republicans were starting to look like they might lose their nerve to repeal the program outright.

“No one has ever said we are going to have this repealed and replaced on such and such a date,” Risch said. “This is 3,000 pages of legislation, thousands of pages of regulations on arguably the most complex sector of our economy, the most personal matter of our economy and to say ‘we’re going to walk in one day and redo this thing’ I think overly ambitious. It’s overly optimistic..”

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