An Obamacare Math Problem for House Republicans

As leaders hunt for 218 votes, the repeal plan is facing fire from both the moderate and conservative wings of the GOP.

House Speaker Paul Ryan, accompanied by Majority Leader Kevin McCarthy, meets with reporters on Tuesday to discuss efforts to replace the Affordable Care Act, following a closed-door meeting with the GOP caucus.
(J. Scott Applewhite/Associated Press)
Daniel Newhauser
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Daniel Newhauser
Jan. 10, 2017, 8:01 p.m.

An emer­ging cen­ter-right co­ali­tion in the House is threat­en­ing to stall Re­pub­lic­an lead­ers’ first pro­ced­ur­al move to­ward re­peal of Pres­id­ent Obama’s sig­na­ture health care law this year.

Mem­bers of the mod­er­ate Tues­day Group and the con­ser­vat­ive House Free­dom Caucus are sep­ar­ately voicing con­cerns that House lead­ers are rush­ing a vote to re­peal Obama­care without giv­ing mem­bers in­put or out­lining how spe­cific­ally they would re­place the law.

Some are call­ing for Speak­er Paul Ry­an to delay a cru­cial vote sched­uled for Fri­day on a budget res­ol­u­tion that would lay the ground­work for Con­gress to re­peal Obama­care without fa­cing the threat of a fili­buster in the Sen­ate—where some Re­pub­lic­ans have voiced sim­il­ar con­cerns this week.

On Tues­day af­ter­noon, the Tues­day Group met to dis­cuss their re­ser­va­tions. Rep. Charlie Dent, the group’s co­chair­man, said he and oth­ers be­lieve the re­peal and re­place­ment of the law should oc­cur as close to­geth­er as pos­sible. Mem­bers of the group are wor­ried that House lead­ers will set up a re­peal of the law but fall prey to polit­ic­al dead­lock when the time comes to re­place it with le­gis­la­tion of their own, po­ten­tially leav­ing their con­stitu­ents without in­sur­ance cov­er­age.

“Many of our mem­bers un­der­stand that this is the first step in the pro­cess, and be­fore we launch this le­gis­lat­ively, we’d like to have a say in what the re­place­ment pack­age is,” Dent said. “Many of us are con­cerned that if we re­peal Obama­care without a re­place­ment, the lever­age will be lost to re­place, be­cause there will be those on the Left who will not help us un­der any cir­cum­stances and there will be some on the hard Right who might view any re­place­ment as ‘Obama­care Light.’”

House lead­ers are try­ing to as­suage un­eas­i­ness over the lack of a con­crete re­place­ment plan by not­ing that much of the heavy lift­ing can be done by the ad­min­is­tra­tion. Vice Pres­id­ent-elect Mike Pence told mem­bers last week that Pres­id­ent-elect Trump plans to use ex­ec­ut­ive ac­tions to re­peal parts of the law. The mes­sage from House lead­ers this week is that Rep. Tom Price, Trump’s nom­in­ee to head the Health and Hu­man Ser­vices De­part­ment, can al­ter the law on his own, for in­stance by lower­ing the min­im­um stand­ards for an in­sur­ance plan to qual­i­fy as cov­er­age un­der the law.

But with Trump not yet in of­fice and Price not yet con­firmed by the Sen­ate, mem­bers are ap­pre­hens­ive about ini­ti­at­ing the re­peal pro­cess. And mem­bers of the Tues­day Group are sim­il­arly con­cerned by am­bi­gu­ity from Trump about how he would like Con­gress to pro­ceed, said Rep. Chris Collins, Trump’s Cap­it­ol Hill li­ais­on.

That con­cern was not helped by a Tues­day Trump in­ter­view in The New York Times, in which he said Con­gress should re­peal Obama­care “prob­ably some­time next week”—a week the House is not in ses­sion—and ad­ded that “the re­place will be very quickly or sim­ul­tan­eously, very shortly there­after.”

Mem­bers of the House Free­dom Caucus have also been voicing re­ser­va­tions about mov­ing the budget this week. The group’s chair­man, Rep. Mark Mead­ows, said mem­bers want more cer­tainty about how lead­ers want to re­place the law.

“That would be very help­ful to have le­gis­lat­ive text. That might be an ask that is too great at this point, but at least a com­mit­ment to get it done in the 115th Con­gress—we’ve been con­sist­ent on that,” he said. “We be­lieve there is no com­pel­ling reas­on why you can’t get this done in the 115th Con­gress. It is my opin­ion that if it is not done in the 115th Con­gress, it will nev­er be done.”

He ad­ded that he would like to see cer­tain taxes used to pay for Obama­care to be re­pealed im­me­di­ately so Con­gress is not temp­ted to re­use them to fund a health-care-law re­place­ment.

The group is not un­an­im­ous on this top­ic. Rep. Mor­gan Grif­fith, for in­stance, said he would vote for the budget, even though he has mixed feel­ings.

“It’s a vehicle to get to where we want to go, so I’m go­ing to vote yes,” he said. “There are some who want more spe­cif­ics and maybe it ought to be delayed as op­posed to [voted on] Fri­day, and I’m sym­path­et­ic to that, but at some point we’ve got to do it be­cause we’ve got to get that vehicle mov­ing.”

Still, some mem­bers of the Tues­day Group com­bined with some mem­bers of the House Free­dom Caucus could equal enough law­makers to keep the budget from passing, since no Demo­crats are ex­pec­ted to back the meas­ure. House Ma­jor­ity Whip Steve Scal­ise and his team have been gauging sup­port on the budget meas­ure, and at a morn­ing meet­ing, he urged any mem­bers who have con­cerns to share them with him.

The House dy­nam­ics echo those in the Sen­ate, where both mod­er­ate and con­ser­vat­ive sen­at­ors have ex­pressed re­ser­va­tions about mov­ing ahead with an Obama­care re­place­ment be­fore co­ales­cing around an al­tern­at­ive plan.

Sen. Rand Paul said there needs to be a vote on a re­place­ment the same day as re­peal, but cla­ri­fied that his goal is not to block the strip­ping of the health care law but to quick­en the pace to a Re­pub­lic­an al­tern­at­ive.

Both Sens. Bill Cas­sidy and Susan Collins said they need to see a de­tailed plan.

“In an ideal situ­ation, we would re­peal and re­place Obama­care sim­ul­tan­eously, but we need to make sure that we have at least a de­tailed frame­work that tells the Amer­ic­an people what dir­ec­tion we’re headed,” said Collins in a state­ment.

Ef­forts with­in the party to delay a re­peal are un­der way. Sen. Bob Cork­er sub­mit­ted an amend­ment to the budget res­ol­u­tion to push back the date for a re­con­cili­ation bill from Jan. 27 to March 3. Sens. Rob Port­man, Lisa Murkowski, Collins, and Cas­sidy were co­spon­sors of the amend­ment.

Collins ex­plained that a sense of dir­ec­tion is needed so as not to dis­rupt cov­er­age and to al­low the in­sur­ance mar­ket to ad­just.

“I’m wor­ried about the in­di­vidu­als who are de­pend­ent on the sub­sidies provided by Obama­care,” she said. “My No. 1 con­cern is that we not cre­ate a gap in cov­er­age for in­di­vidu­als who are cur­rently in­sured and who rely on that cov­er­age. I’m also con­cerned that the in­sur­ance in­dustry will not have time to ad­apt to the dra­mat­ic changes brought about by re­peal without a frame­work for re­place­ment. The in­sur­ance mar­kets can­not turn on a dime.”

Erin Durkin contributed to this article.
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