| Huffington Post | - |
Anxiety
about repealing Obamacare without a replacement got a lot more visible
in the U.S. Senate on Monday evening, as a half-dozen Republican
senators called publicly for slowing down the process.
TRENDING
A Half-Dozen GOP Senators Just Fired A Big Warning Shot On Obamacare Repeal
Cries to slow down and wait for a replacement are getting louder.
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Anxiety about repealing Obamacare without a replacement got a lot more visible in the U.S. Senate on Monday evening, as a half-dozen Republican senators called publicly for slowing down the process.
It’s not clear how strongly these
senators feel about it, or whether they are willing to defy party
leadership over how and when efforts to repeal Obamacare proceed.
But
at least three other GOP senators have now expressed reservations about
eliminating the Affordable Care Act without first settling on an
alternative. That brings the total to nine ― well more than the three
defections it would take to deprive Republicans of the majority they
would likely need to get repeal through Congress. And the restlessness isn’t confined to the Senate. Members of the House Freedom Caucus on Monday evening issued their own call for slowing down the repeal process.
At the very least, these
developments suggest that taking President Barack Obama’s signature
domestic policy off the books is unlikely to go as smoothly or as
quickly as GOP leaders once hoped.
The change in the political environment has been perceptible, and relatively sudden. Following the election of Donald Trump
in November, GOP leaders indicated they intended to move immediately on
Obamacare repeal, using expedited procedures reserved for certain
fiscal issues.
First,
Congress would pass a budget resolution, instructing committees with
jurisdiction over health care to write repeal legislation. Once
that work was done, the House and Senate each would vote on the
legislation, work out their differences, and send a bill to the White
House, where Trump would presumably sign it.
The
budget resolution is supposed to pass this week, and, as written, it
calls for the committees to finish their work by Jan. 27 ― just a little
more than two weeks from now.
But
as the prospect of repealing Obamacare has suddenly ceased to be
hypothetical, Republicans have confronted all sorts of questions ― not
least among them what will happen to the roughly 20 million people
getting insurance through the program right now.
Initially,
GOP leaders responded by promising to let elements of Obamacare remain
in place for a short time, setting up a transition period during which
people who have Obamacare coverage would theoretically get to keep it. But
over the past few days, several GOP senators have said that this
“repeal-and-delay” strategy still leaves too much uncertainty about what
would follow Obamacare, and have called for settling on a replacement
plan ― or at least the outlines of one ― before voting on repeal.
On Monday, five of them put their protests on paper ― by introducing an amendment to the budget resolution that would push back that Jan. 27 date until March 3.
“Repeal
and replace should take place simultaneously, and this amendment will
give the incoming administration more time to outline its priorities,”
Sen. Bob Corker (R-Tenn.) said. “By exercising due diligence we can
create a stable transition to an open health care marketplace that
provides far greater choice and more affordable plans for the American
people.”
The
four other GOP senators behind the amendment are Bill Cassidy (La.),
Susan Collins (Maine), Rob Portman (Ohio), and Lisa Murkowski (Alaska).
As
a legal matter, the amendment wouldn’t mean much. Neither the old nor
the new deadline would be binding, Capitol Hill aides said, and it’s
entirely possible that Monday’s statement will prove an empty gesture.
Nor is it likely that one extra month would give Republicans enough time to settle on an Obamacare replacement.
But
the decision to propose the amendment ― and to attach strong quotes to
it ― could also indicate something more, as Jim Manley, longtime aide to
former Sen. Harry Reid (D-Nev.) and before that the late Sen. Edward
Kennedy (D-Mass.), told The Huffington Post.
“The
senators on this letter are smart enough to realize that the train is
about to leave to station when it comes to repealing Obamacare without
any alternative,” Manley said. “And they want to slow down the process
by offering this amendment before the legislative process starts
spiraling out of control.
“This
letter is yet the latest indication that at least some Republicans
realize that just simply repealing Obamacare without any viable
alternative in place is completely unworkable and unrealistic and maybe
just a little bit crazy,” Manley said.
The other big development on Monday was a statement from Sen. Lamar Alexander (R-Tenn.). According to Talking Points Memo,
Alexander said, “We have to take each part of it and consider what it
would take to create a new and better alternative and then begin to
create that alternative, and once it’s available to the American people,
then we can finally repeal Obamacare.”
It’s
difficult to know how far Alexander or other Republican senators are
willing to go on slowing Obamacare repeal, particularly if they face
intense pressure from party leaders and conservative activists.
Shortly after the
election, for example, Alexander said that Republicans needed to put
their replacement together before going forward with repeal. “What we
need to focus on first is what we would replace it with and what are the
steps we would take to do that,” he told reporters on Nov. 17.
“I imagine [it] will take several years to completely make that sort of
transition to make sure we do no harm, create a good health care system
that everyone has access to and we repeal the parts of Obamacare that
need to be repealed.”
But after Senate Leader Mitch McConnell
(R-Ky.) indicated that repeal would include a transition period,
Alexander got in line. “The American people expect us to” repeal, he
told reporters in the Capitol on Dec. 1, endorsing the repeal and delay strategy.
“I think Senator McConnell wants to make it an early item. And the
important thing to emphasize is it’s just a beginning. ... We want to
start immediately, but it’ll take a matter of years to fully replace and
rebuild the health care system that it has taken six years to damage.”
Alexander’s
new statements would appear to suggest he’s still not comfortable with
moving quickly. And that’s critical, given the role he would play in any
Obamacare repeal effort, as a senior, widely respected member of the
caucus ― and, more important, as chairman of the Health, Education,
Labor and Pensions Committee, which has direct jurisdiction over health
care legislation.
The
reticence about junking Obamacare too hastily reflects certain
realities that the GOP hasn’t really confronted until now. Different
elements of the party have wildly different perspectives on what a new
system should look like. And delivering the kind of financial protection
most Americans want without dramatically reducing the number of people
with insurance is going to be difficult, if not impossible, without the
kind of federal spending most Republicans oppose.
Two
senators proposing the budget amendment touched on those concerns.
Cassidy, who is a physician, spoke specifically about the needs of
people with serious medical problems ― the type of people who, in the
years before Obamacare, could sometimes be denied coverage because of
pre-existing conditions, or would run up against lifetime limits on
benefits.
“As
Obamacare is repealed and replaced, we must always keep in mind the mom
with a breast lump who cannot afford Obamacare and wants something
better but also needs to maintain her coverage,” Cassidy said. “This
amendment will ensure adequate time is given to repeal Obamacare AND
replace it with a substantive alternative that will work for her.”
Murkowski
focused on importance making insurance widely available: “I remain
committed to repealing the Affordable Care Act,” she said, “and I am
equally committed to ensuring that all Alaskans and Americans,
especially the most vulnerable among us and those in rural communities,
have access to affordable, quality health care.”
Repealing
Obamacare was a top priority for Trump during his campaign, and his
call thrilled the millions of voters who say they are angry about the
law. But Trump also vowed that
“everybody has got to be covered,” which is not a promise that GOP
leaders like House Speaker Paul Ryan (R-Wisc.) have endorsed.
Although polls
have consistently shown pluralities of Americans disapprove of the law,
those same polls have shown that most of its elements ― including not
just protections for people with pre-existing conditions, but also tax
credits for buying insurance ― to be highly popular.
Senate
Republicans have seen those polls, just as they have heard from GOP
governors in states that have expanded Medicaid eligibility using
funding that Obamacare made available. Those governors, among them Gov.
John Kasich (R-Ohio), have said that it’s important to make sure
Republicans have an alternative ready to go before getting rid of
Obamacare.
Meanwhile, three other GOP senators ― Tom Cotton (Ark.), John McCain (Ariz.), and Rand Paul (Ky.) ― have expressed reservations about repeal without a replacement, albeit for different reasons.
How Trump feels about all of
this remains something of a mystery. On Monday evening, he and his
advisers huddled with Capitol Hill Republicans over several matters.
Afterwards, in response to a reporter’s question about the specifics of
repealing and replacing Obamacare, Trump adviser Steve Bannon said they
were “still thinking that through.”
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