Republicans scramble on ObamaCare replacement plan

Several Republican senators are getting cold feet over the GOP plan to repeal ObamaCare without a replacement, leaving the party scrambling to find a consensus around an alternative. 

Blueprints, white papers and op-eds are aplenty but few of these ideas have been put into legislative language. Most stick to traditional Republican healthcare orthodoxy.

“If you look, there is a coalescence of ideas,” Sen. Bill Cassidy (R-La.) said, ticking off a list of principles most plans contain, such as advanceable, refundable tax credits and per capita caps for Medicaid.

Meanwhile, the Senate is moving forward to pass a non-binding budget resolution, likely mid-week — the first step in the process of unraveling President Obama’s signature health law.

{mosads}

While some Republicans have in recent days called for simultaneous repeal and replace, lack of a replace may be part of the problem with that approach. 

To that point, a group of GOP senators is seeking more time to work on a replacement, calling to push back the repeal date to March 3.

Paul’s proposal.

Sen. Rand Paul (R-Ky.) is a vocal backer of the repeal and replace at the same time strategy, and will introduce a bill that he says has the backing of President-elect Donald Trump sometime this week.

Paul told The Hill Extra he is gathering conservative support for his bill, which will remove many of the law’s mandates in an effort to bring the cost of insurance down. 

“We’re taking some of the most popular Republican ideas out there, and we are collecting them together in one bill,” Paul said.

The core element of Paul’s plan is similar to most of the other Republican ideas presented to date — it would expand the use of tax-advantaged health savings accounts to help people afford insurance.

But the plan won’t aim to cover all of the estimated 20 million people who have gained coverage through the ACA, nor will it keep some of the most popular, and most expensive, provisions of ObamaCare.

In addition to rolling back the law’s employer and individual mandates, it would also roll back the prohibition on insurance companies denying coverage to people with pre-existing conditions.

Some experts say that could be a recipe for disaster for insurance companies if they don’t have a steady pool of patients now required to sign up.

Paul said the focus will be on lowering healthcare costs through cheaper plans.

“We should legalize inexpensive insurance,” Paul said, “which means that we get rid of the ObamaCare mandates that prevent insurance companies from selling inexpensive policies.”

Individuals not covered through the plan will be backed up by Medicaid, Paul said, but he will leave the financing of that program up to the states.

Other Senate plans.

Paul’s idea isn’t the Senate’s first attempt at an ObamaCare replacement, but it will be one of the first bills, rather than abstract blueprints or white papers.

In February 2015, Senate Finance Committee Chairman Orrin Hatch (R-Utah), Sen. Richard Burr (R-N.C.) and House Energy and Commerce Chairman Fred Upton (R-Mich.) released a bicameral blueprint.

Their Patient CARE Act advocated for state high-risk pools, bolstered health savings accounts and included a tax credit to help some individuals buy insurance and more.

As the Supreme Court debated King v. Burwell — which could have resulted in millions losing their subsidies to help pay for HealthCare.gov plans — Republicans discussed what should come next.

Top-ranking senators — Hatch, Senate health panel chairman Lamar Alexander (R-Tenn.) and Senate Republican Policy Committee Chairman John Barrasso (R-Wyo.) — wrote an op-ed in The Washington Post on March 1, 2015, saying “Republicans have a plan to bridge away from ObamaCare.” This included providing financial assistance during a transitional period and granting states increasing flexibility.

Cassidy introduced the Patient Freedom Act in June 2015 giving states three options — continue ObamaCare on a state exchange, do nothing or enact his bill. And he’s almost wrapped up a new version of a replacement bill.

Senate Majority Whip John Cornyn (R-Texas) said Thursday that “there’s a multitude of plans and ideas and bills that have been out there for six years.”

“It’s a matter of trying to choose and it’s also a matter of where the consensus lies,” he said.

How about the House?

When House Speaker Paul Ryan (R-Wis.) hears criticism that his chamber doesn’t have a plan to replace ObamaCare, he points to the ideas in “A Better Way.”

The 37-page document is perhaps the best known of the replacement plans. It was crafted by four high-ranking chairmen and was meant to serve as a guideline for what legislative text for a new health law could look like — though this was well before the Republicans knew they would control both Congress and the White House.

The Republican Study Committee also released legislative language last week fully repealing ObamaCare, letting insurers sell plans across state lines and creating a standard tax deduction for health insurance. The RSC has released similar proposals during the past two congressional sessions. 

Rep. Tom Price (R-Ga.) also has put his ideas into legislative text. Trump’s pick to lead the Department of Health and Human Services has introduced a plan in every Congress since 2011 (except this session). The Empowering Patients First Act would repeal ObamaCare, in favor of what he calls “patient-centered solutions.” 

His plan contains some controversial ideas, such as capping the tax exclusion for employer-sponsored insurance plans. 

See more exclusive content on policy and regulatory news on our subscription-only service here.