In a closed-door meeting in the House basement Wednesday with the whip team, a Republican rank-and-file member rose to convey his deep fear that Republicans were making a big mistake by repealing the Affordable Care Act without any concrete plan to replace it with.
According to one source in the room, the member rose and got the room’s attention.
“You lose all leverage once you repeal this thing. There will be people on the left who will never help you replace it and there will be people on the right who aren’t going to help you either,” the member said. “We will own this thing and there will be consequences.”
The focus in the House at the moment has been on how to repeal the Affordable Care Act. The goal is to have a repeal bill on President-elect Trump’s desk by the end of February. Repealing Obamacare, after all, is what Republicans have been campaigning on for the last seven years. But the problem is that repealing Obamacare now and replacing it later could come with a myriad of policy and political baggage.
The House isn’t the only place where members are sounding the alarm. Sen. Rand Paul (R-KY), whose own state expanded Medicaid under the Affordable Care Act, said earlier this week that Republicans will be making a mistake if they repeal the Affordable Care Act without replacing it at the same time.
The concern is that by moving rapidly to repeal President Obama’s signature accomplishment, Democrats may never work with Republicans on a replacement. That could leave Republicans with two options, either they could change Senate rules and jam through their replacement or they will never get one.
While Republicans say they want a two- to three-year transition to protect people who have benefited from Obamacare from losing their insurance, health care experts have warned that even with a transition, a repeal bill without a clear replacement could lead the insurance market to devolve into chaos.
It’s why some rank-and-file Republicans have been clear that they’d feel more comfortable if leadership had a strong plan in place before they ripped up the ACA.
“They are talking about replacing it at some point, but they are operating under the allusion that somehow that we’ll be able to put pressure on the Senate Democrats to come to some kind of a replacement because there are going to be issues in their states that need to be addressed,” the source in the room said. “I’m not yet persuaded.”
“I personally would like to have a replacement at the time of repeal, and I think there are a number of members that feel that way,” said Rep. David Rouzer (R-NC). “I think all of this will work itself out.”
As Congress returns from a lengthy holiday break, Republican leaders are beginning to more intently lay out the roadmap for how best to tackle their key legislative goal. On Wednesday morning, Vice President-elect Mike Pence came to the Hill to vaguely outline his expectations for repealing health care, but members in the meeting said his outline was light on details and focused on ensuring individual Americans aren’t hurt by Republican efforts. He wanted members to be “mindful of not disrupting the markets,” according to one member in the meeting.
Health care experts have estimated between 20 and 30 million people could lose their insurance if Obamacare is repealed.
Rep. Mark Amoedei (R-NV) said he wants to see Republicans in the House actually hold hearings on both repealing and replacing Obamacare. He said he wants the process to be slower, clear and transparent for the public, but he also noted there is only so much time to come up with a replacement.
“It’s the old Benjamin Franklin saying, ‘Well done is better than well said.’ So we better do a good job of well done. It needs to be fixed, but do a good job of fixing it,” Amoedei said. “If [a replacement] hasn’t been done by 2018, it’s like what are you doing?”
On Wednesday, it appeared that the gravity of what Republicans are trying to accomplish began to sink in. No longer is repealing Obamacare just a campaign tagline. It’s a complicated and multi-faceted process that will come with substantial political risk.
“The issue is there are so many moving parts that have to be addressed. It is very difficult how all those pieces work at this stage and people have different expectations out in the states. Many of the states will have different consequences depending on the timing of when the replacement comes along,” Rep. John Faso (R-NY) told TPM.
At this point, Republican leaders still seem committed to repealing Obamacare first before a replacement comes along. Ways and Means Chairman Kevin Brady (R-TX) told TPM that reconciliation would move first and then any pieces of Obamacare that couldn’t be repealed through reconciliation would be repealed through subsequent legislation.
“There will be several steps,” Brady told TPM.
Brady said that he has had discussions with Democrats to try to repeal the law with legislation, but that “they feel pretty strongly about the current law and believe it can be fixed.”
Rep. Todd Rokita, the vice chairman of the House Budget Committee, said he disagreed with analysis that repeal and replace had to be done simultaneously.
“I don’t necessarily agree with that when there is a two-year transition to get off of this,” Rokita told TPM. “Our job is going to have to be to decide what we are going to be replacing with and there are great plans out there already we just have to coalesce them into one package. The replacement has to come after the repeal from a process standpoint.”
Rokita argued that President-elect Trump will have to go out and pressure Democrats to get on board.
“He’s going to have to be in Senate Democrats’ states pointing out that particular senator is the problem to the American people getting a better replacement. We are going to have a better replacement. It is going to be driven by consumer choices, not government choices,” Rokita said.
It’s possible that in order to repeal all the parts of Obamacare or replace it, Republicans in the Senate would have to override the parliamentarian. Brady wouldn’t comment on if that was still a possibility, only adding that they are having “lots of discussions.”
“The Senate really drives the reconciliation with the Byrd rules. The House will continue to advance major reforms. The Senate, with the rules, have a tougher challenge,” Brady told TPM.
Rokita also wouldn’t weigh in on whether the Senate should just jam through a fuller repeal and override the parliamentarian.
“That is a discussion for a different day,” Rokita said.