Obamacare Repeal Path Is Narrower in 2018

Some Republicans still want to get rid of the health care law, but the odds are even tougher than they were last year.

Sen. Lindsey Graham, flanked by Sen. Bill Cassidy (left) and Senate Majority Leader Mitch McConnell, speaks to reporters as they faced assured defeat on the Graham-Cassidy bill, the GOP's latest attempt to repeal the Obama health care law, at the Capitol on Sept. 26.
AP Photo/J. Scott Applewhite
Jan. 3, 2018, 8 p.m.

Ending the individual mandate may be the closest Republicans can get to repealing Obamacare in the near future. But that doesn’t mean they’ll totally give up trying, even in a perilous election year with little time for major legislative action.

Congressional Republicans spent most of last year attempting—and largely failing—to repeal and replace Obamacare. But they got a smaller victory towards the end of the year by using their tax-reform legislation to scrap the most hated part of the Affordable Care Act: the penalty that people have to pay if they fail to obtain health coverage.

As lawmakers got closer to their tax-reform victory, some began showing hope they can return to their health-care-overhaul efforts in the new year, possibly by reviving a proposal that was championed by Sens. Bill Cassidy and Lindsey Graham.

“My guess is that it will be, if we are able to move forward and find 50 votes for something, it will probably be along the lines of a Graham-Cassidy approach. That is something that most of our members found a lot of merit in and to be a fairly workable solution,” said Sen. John Thune.

The proposal would replace the tax credits, cost-sharing-reduction subsidies, basic health plans and Medicaid expansion money with a federal block grant. The plan would give states power over how the money is used.

But the bill never made it to the floor for a vote after Senate Republicans failed to come to a complete agreement in September.

And the task of overhauling the health care system has not gotten any easier. The Republican majority in the Senate is now narrower, 51-49, after Democrat Doug Jones pulled a surprise victory in Alabama. Before the holiday recess, Senate Majority Leader Mitch McConnell noted the slim majority and asserted that he will be moving bills that have the votes.

Time is also getting tight. The closer lawmakers get to 2018 midterm elections, the less likely they would be willing to make another move on the ACA. Another Obamacare-repeal battle could potentially overshadow their accomplishment on tax reform and individual-mandate repeal.

Republicans would first have to pass a budget with reconciliation instructions allowing them to dismantle Obamacare with only 51 votes, because they are unlikely to get help from Democrats.

“We’ll be in an election year. The timing of getting a budget resolution and then setting up a reconciliation is a heavy lift. … If the Republicans were going to do this, the more time they can put between ACA repeal and the election the better,” said Molly Reynolds, a fellow in governance studies at the Brookings Institution.

But Graham still believes that Obamacare repeal must be revisited. “I’m fully committed to Repealing and Replacing Obamacare in 2018 by block-granting the money back to the states and away from Washington bureaucrats who are completely unaccountable to the patients of America,” he tweeted last month.

Other lawmakers have insisted that Congress first must pass Obamacare-stabilization legislation that was initially expected to ride on the year-end continuing resolution. The bill, sponsored by Sens. Lamar Alexander and Patty Murray, would restore the cost-sharing-reduction payments for two years. Alexander is pressing the bill to be passed in January.

“Right now the only issue on Obamacare we need to revisit is stabilization of the individual market, cost-sharing-reduction payments,” said Rep. Charlie Dent, who added that it would be an issue for him if repeal was returned to before stabilizing the market first.

Sen. Mike Rounds also said providing the people currently in ACA’s market plans a glide path to a new system is necessary.

“I think you start with Alexander-Murray, and once you have Alexander-Murray in place that gives us the first piece of changing the Obamacare legislation,” he said. “It does two things: No. 1, it relaxes [state innovation waivers], which is critical for the creation of more options for the states. And second of all is you help people with this two-year transition period out of Obamacare.”

In the absence of a large congressional bill dismantling the ACA, President Trump has taken some actions of his own, including signing an order that is expected to make smaller and cheaper plans more available. The move could further destabilize the marketplace.

House Freedom Caucus Chairman Mark Meadows is expecting the administration to make moves on the law, and then Congress can follow with legislative action.

“To be honest, I don’t know that there is a path to repealing it with a 51-vote majority in the Senate and knowing that anything that you touch with the Affordable Care Act generally gets zero Democrat votes,” said Meadows. “But it is on the table, but it would have to be more from an administrative fix and then to see how we can fix it legislatively in a bipartisan way.”

However, Meadows added that lawmakers cannot accept defeat on the issue because of rising health insurance premiums. “Inaction is not an option,” he said. “We’ve got to find a way to bring those premiums down, and I am willing to look outside the box.”

The day after Christmas, Trump gave a boost to lawmakers trying to develop a new health care proposal, and touted the repeal of the individual mandate as repeal of Obamacare. “Based on the fact that the very unfair and unpopular Individual Mandate has been terminated as part of our Tax Cut Bill, which essentially Repeals (over time) ObamaCare, the Democrats & Republicans will eventually come together and develop a great new HealthCare plan!” he tweeted.

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