Republicans working with CBO on details of ObamaCare bill

House Republicans have been working with the Congressional Budget Office on parts of an ObamaCare replacement that they could include in a repeal bill this spring, lobbyists and aides tell The Hill.

They have been working with the CBO, Congress’s nonpartisan budget scorekeeper, on the details of tax credits, high-risk pool funding, and changes to Medicaid that could be included in a repeal bill that Republicans hope to pass by the end of March. The bill will use the fast-track process known as reconciliation to avoid a filibuster by Senate Democrats.

The House Energy and Commerce Committee is shooting for the date of March 1 for its markup of the reconciliation bill, according to a House GOP aide. Other key committees in the House are looking at a similar timeline for markups.

The moves show that House Republicans are pushing ahead with their fast timetable and making some progress on their plans to repeal ObamaCare, even as they face stiff headwinds.

Speaker Paul Ryan (R-Wis.) says that he wants the House to pass the ObamaCare repeal legislation in the “first quarter,” meaning by the end of March.

That is an ambitious timeline. As more details start to become known, the prospects for opposition grow and the timeline could slip.

Some Republican lawmakers have expressed uneasiness about the path forward on repealing the law. Crowds of constituents, worried about the 20 million people who could lose coverage under ObamaCare repeal, have protested in favor of keeping the law in several Republican lawmakers’ districts.

It is unclear if including only some elements of a replacement along with repeal would satisfy the sizable contingent of Republicans who want repeal and replace to happen at the same time.

Republicans say they will later pass a series of other small replacement bills, though some of those could require 60 votes, meaning Democratic support, in the Senate.

The elements include tax credits to help people afford insurance, a central element of Ryan’s Better Way plan released last year. The high-risk pool funding could be a way to help stabilize the insurance market after the repeal bill passes, by providing funding that would help insurers cover sicker people. How much funding will be provided in either of those areas, a key detail, is not yet clear.

When the CBO’s analysis of the bill comes out, it could be a key moment. That report will detail the spending implications of the legislation and likely include estimates of how many people, if any, might lose coverage.

The Senate is also taking a significantly slower pace on ObamaCare legislation, and many Republican senators have concerns on Medicaid and other issues.

The changes to Medicaid are one of the thorniest questions that Republicans are still working through. Republicans from states that expanded Medicaid under ObamaCare have been protective of keeping the extra federal funding and expanded coverage, while those from states that did not expand do not want to be treated unequally under a replacement.

There is also a question if Republicans will move towards capping federal payments to states under Medicaid, a move strongly opposed by Democrats who say the change would lead to harmful cuts. Concerns from Republican governors about Medicaid changes are also key.

“We had good conversations with the governors about this, and it’s an issue in our conference because we have members whose states took it and members whose states didn’t,” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) told reporters last week, speaking of the Medicaid expansion. “We want to be equitable about this.”

He acknowledged that the issue would need to be resolved for repeal to have enough votes to pass.

“We’re cognizant of this issue and fundamentally, if we don’t find the right sweet spot, we aren’t going to be able to pass it,” Walden said. “I know how to count.”