This is the first in a series of articles examining major issues facing President-elect Donald Trump following his inauguration.
Republicans want a fast-track repeal of Obamacare, but fully scuttling and replacing the landmark health care law may take longer than some want and may require several steps that could stretch out months or years.
President-elect Donald Trump vowed to submit a plan to “repeal and replace” the Affordable Care Act “essentially simultaneously.” The Republican-controlled Senate took the first step by approving a budget resolution Thursday that begins to lay the groundwork for a repeal. The House followed suit on Friday. But there is no timetable yet on how fast Trump and the GOP fully can — or want to — follow through on their campaign promise.
There could be a lag between beginning the repeal process and actually implementing a new health insurance program, House and Senate members have said. A number of key Republicans are saying they don’t want to complete the first step before the second is ready to go. As the presidential inauguration looms, repealing the law appears to be easier than getting agreement on how to replace it.
“That is a placeholder,” Sen. Bob Corker (R-Tenn.) said as the Senate voted on the budget resolution that requires Congress to draft repeal legislation by Jan. 27. Corker along with four other Republicans separately are calling for pushing that date back to March.
“I don’t see any possibility of our being able to come up with a comprehensive reform bill that would replace Obamacare by the end of this month,” Sen. Susan Collins (R-Maine) told National Public Radio.
Even the “Freedom Caucus,” a group of 40 of the most conservative members in Congress, is tapping its foot on the brake. Its leader, Rep. Mark Meadows (R-N.C.), has called for replacing Obamacare during the current two-year congressional term but doesn’t want to see it done in the first few weeks.
“We need to slow down the process so we can understand a little bit more the specifics and the timetable of replacement votes and reconciliation instructions, etc.,” Meadows told reporters earlier last week, according to several accounts.
Part of the reason is that Congress could quickly repeal parts of the ACA dealing with taxes and spending by going through the budget process. But it can’t go that route to address elements regarding coverage, such as mandating insurance companies cover people with pre-existing conditions.
Tax hikes feared
If Republicans act quickly to reduce the revenue but can’t reduce the program obligations, Congress could be stuck with raising taxes in the short-term, Corker and others have warned.
One, Sen. Rand Paul (R-Ky.), a doctor and former presidential candidate, said the GOP should advance a replacement plan first, before taking a repeal vote. To do otherwise would be adding to the national debt, he warned.
Americans don’t seem to want a full repeal. According to a Quinnipiac University poll last week, 18 percent of respondents say Trump and Congress should repeal all of the ACA, while 47 percent say repeal parts of it and 31 percent say Congress should not repeal any of it.
Signed into law in 2010, the Affordable Care Act reduced the number of uninsured in the nation by basically requiring people to obtain coverage, through either taxpayer-subsidized private insurance or state Medicaid programs. It provides health care for about 20 million Americans.
“We’re giving more benefits and protections for folks who already have health insurance, and we created a new market — basically a big group plan — for folks without health insurance so that they get a better deal, and then we’re providing tax credits to help folks afford it,” Obama said shortly before the plan went into effect.
Among other things, the law prevents insurance companies from denying coverage to people with pre-existing conditions, and allows those younger than 26 to stay on their parents’ health plans.
“We fought to make sure that in America, health care is not just a privilege, but a right for every single American,” the president later said.
But critics decried a sloppy rollout (computer glitches slowed early enrollments and made it difficult for applicants), rising costs for some, and rising coverage obligations. Premiums paid by employees for workplace coverage increased by hundreds of dollars, and the average deductible doubled, according to a recent Kaiser Family Foundation study.
“It’s becoming more and more and more expensive,” House Speaker Paul Ryan (R-Wis.) said on his website. “This thing is collapsing under its own weight and we have to step in and save people from this.”
Several lawsuits challenged the law, especially the legality of the insurance mandate. In 2012, the U.S. Supreme Court upheld the ACA.
Now, with control of the White House and Congress, Republicans say they will act quickly to undo the law.
“We’re going to be submitting — as soon as our secretary’s approved, almost simultaneously, shortly thereafter, a plan. It’ll be repeal and replace. It will be essentially simultaneously,” Trump said last week. “Probably the same day, could be the same hour.”
If that’s the case, Trump is signaling that completing the process will take a bit of time. That said, the GOP might, for strategic reasons, schedule a repeal vote early in Trump’s tenure to be able to declare a political victory, even if implementation lags.
As when the ACA was initially passed, repeal has become a fiercely partisan battle.
Senate Minority Leader Chuck Schumer (D-N.Y.) reportedly has told Republicans that if they vote to void Obama’s signature law, Democrats won’t help them pass new legislation.
“Turn back before it’s too late,” Schumer said on the Senate floor during the budget resolution vote, according to The Associated Press. “It will damage your party and it will hurt millions of Americans, far more importantly.”
Sen. Ron Johnson (R-Wis.) said that replacing Obamacare would take multiple steps. On NPR, he likened it to replacing a bridge: You don’t blow up the old bridge first.
“If you had a bridge that’s about ready to collapse, you know, the first thing you would do is you’d start working to repair that bridge,” Johnson said. “Repair that, so people can use it while you start building other bridges.”
Speaker Ryan said Democrats’ warnings that Americans will lose coverage are scare tactics.
“The rug’s not going to be pulled out from under people,” Ryan said. “There’s clearly going to be a transition period until you can get a new and better system up and running so that people will not have that rug pulled out from under them.”