Trump, GOP at crossroads on repealing ObamaCare

In a significant development, President-elect Donald Trump on Tuesday called on Republicans to pass an ObamaCare replacement within “weeks” after repeal. 

Trump’s comments urging his party to act quickly on a replacement come as a growing group of congressional Republicans is expressing serious concerns about moving forward quickly on repeal without having a replacement plan ready, or at the least the outlines of one. 

Just weeks ago, Republicans had floated the possibility of passing a replacement bill two or even three years down the road.

“Long to me would be weeks,” Trump told The New York Times on Tuesday. “It won’t be repeal and then two years later go in with another plan.”

However, Republican congressional leaders have declined to commit to passing a replacement in “weeks” or providing any specific timeline beyond sometime this year. They are still moving forward with their plan to pass a repeal of the law before a full replacement is ready.  

{mosads}Senate Majority Leader Mitch McConnnell (R-Ky.), asked about Trump’s comments, declined to commit to a timeline for a replacement, saying that the process is still being worked out. 

“We’ll be working with the president’s nominees, Tom Price, Seema Verma, who’ll be helping us craft the way forward,” McConnell said, pointing to two of Trump’s Department of Health and Human Services nominees. 

After meeting with House Republicans behind closed doors on Tuesday, Speaker Paul Ryan (R-Wis.) told reporters, “It is our goal to bring it all together concurrently. We’re going to use every tool at our disposal through legislation, through regulation, to bring replace concurrent along with repeal, so that we can save people from this mess.”

Nearly seven years after the passage of the Affordable Care Act, some Republican lawmakers also acknowledge that they have much work to do on a replacement and would likely not be ready to put forward a replacement plan on Trump’s timeline of “weeks” after a quick repeal anyway. 

Sen. Bill Cassidy (R-La.) is one of five Republican senators pushing to delay the deadline for a repeal bill from Jan. 27 to March 3 to give more time to work on a replacement. 

“Clearly if we go by the 27th of this month, the four major elements that we have to resolve, we won’t have time to resolve,” Cassidy said. “Those being: What can Tom Price do? How do we pay for it? What is the blueprint or the pathway forward for repeal? We  may need something that needs a 60-vote threshold.”

Senate Majority Whip John Cornyn (R-Texas) pushed back on this idea of a delay, though, saying it could clog up the Senate schedule and cause a “jam” for legislation.

Republican leaders in both chambers on Tuesday mentioned the possibility of including some elements of a replacement plan in the repeal measure. But they were not specific about which elements those would be, and it appears that Trump was talking about speedy action on a full replacement, not just elements of it. 

“I think there could be elements of a replacement included in a first reconciliation bill,” Sen. John Thune (S.D.), the No. 3 Senate Republican, said when asked about Trump’s comments. 

“We’re in the process of sorting out the timing of it,” he acknowledged. “But everybody’s agreed that it has to be repealed and it has to be replaced with something better.”

Putting forward a detailed replacement plan would be a tough task for Republicans, forcing them to confront tradeoffs on cost and answer questions like whether their plan would cover as many people as ObamaCare. 

Republican leaders have so far declined to commit to covering as many people as ObamaCare, meaning some of the 20 million covered by the law could lose their insurance. 

Congressional Republicans are also split on whether to immediately repeal ObamaCare’s tax increases, with some worrying about the lost revenue, while conservatives push to repeal as much as the law as possible. 

On Friday, Sen. Rand Paul (R-Ky.) tweeted that he talked to Trump, adding that the president-elect “fully supports my plan to replace ObamaCare the same day we repeal it.”

Many healthcare experts have warned that the current congressional strategy to repeal the law, even on a delay, without having a replacement ready would plunge the health system into chaos. Insurance companies, for example, could drop out of the marketplace due to uncertainty, reducing or eliminating altogether coverage options for people, or hiking their premiums. 

Some Republican lawmakers are also echoing those concerns. 

“I’m not alone,” Sen. Bob Corker (R-Tenn.) told reporters Tuesday. “There are a lot of people y’all have written about and then a whole lot more beyond that that you haven’t written about that have concerns about doing a repeal with no replacement, or at least some guidance on a replacement.”

Still, no Republican senator has said yet that he or she will vote against the repeal bill, and several with concerns expressed hope that more details could bring them on board.  

“Yeah, as long as I know that there’s a pathway forward,” Cassidy said when asked if he would vote for the eventual repeal bill. “I think we’re in the development of it, I would just like to have it a little further fleshed out.”

The first step to setting up the fast-track repeal process is passing a budget this week. 

The conservative House Freedom Caucus expressed concern about voting on Friday without having more details on repeal and replacement, but leaders are going forward with the vote. 

Freedom Caucus members have not taken an absolute stand and still could come around. 

If some replacement elements are included in an initial repeal bill, as Ryan indicated Tuesday, it is not clear what they would be. 

Throughout his two terms, President Obama has consistently jabbed Republicans for not coalescing behind a replacement bill.

Some GOP lawmakers have mentioned expanding the use of health savings accounts or regulatory action to loosen ObamaCare’s rules for what services insurance plans must cover. 

But Republicans have much work to do on a full replacement, and Democrats are already accusing them of repealing the law while essentially hiding their plan to replace it. 

Rep. Chris Collins (R-N.Y.), a close Trump ally, said Tuesday afternoon that more than 23 Republicans spanning from the centrist Tuesday Group to the conservative Freedom Caucus were expressing trepidation about voting to repeal the law without a replacement.

“We do have members who feel if we don’t do them together, the replacement may never happen,” Collins said.

Jordain Carney and Cristina Marcos contributed.