6 hours ago ... "The fact is, we cannot repeal Obamacare through reconciliation," said ... Behindclosed doors, Republican lawmakers fret about how to repeal ...
Behind Closed Doors Republican Lawmakers Fret About How To Repeal Obamacare News
President
Trump, accompanied by Vice President Pence, center, shakes hands with
House Speaker Paul D. Ryan (R-Wis.) on Thursday at a Republican
congressional retreat.(Matt Rourke/AP)
PHILADELPHIA — Republican lawmakers aired
sharp concerns about their party’s quick push to repeal the Affordable
Care Act at a closed-door meeting Thursday, according to a recording of
the session obtained by The Washington Post.
The
recording reveals a GOP that appears to be filled with doubts about how
to make good on a long-standing promise to get rid of Obamacare without
explicit guidance from President Trump or his administration. The
thorny issues with which lawmakers grapple on the tape — including who
may end up either losing coverage or paying more under a revamped system
— highlight the financial and political challenges that flow from
upending the current law.
Senators and House
members expressed a range of concerns about the task ahead: how to
prepare a replacement plan that can be ready to launch at the time of
repeal; how to avoid deep damage to the health insurance market; how to
keep premiums affordable for middle-class families; even how to avoid
the political consequences of defunding Planned Parenthood, the women’s
health-care organization, as many Republicans hope to do with the repeal
of the ACA.
“We’d
better be sure that we’re prepared to live with the market we’ve
created” with repeal, said Rep. Tom McClintock (R-Calif.). “That’s going
to be called Trumpcare. Republicans will own that lock, stock and
barrel, and we’ll be judged in the election less than two years away.”
At
the Republican retreat for members of Congress in Philadelphia,
President Trump's tweets, speeches and executive orders derailed the
GOP's plan to agree upon a replacement for Obamacare and set other
policy initiatives. (The Washington Post)
Recordings
of closed sessions at the Republican policy retreat in Philadelphia
this week were sent late Thursday to The Post and several other news
outlets from an anonymous email address. The remarks of all lawmakers
quoted in this article were confirmed by their offices or by the
lawmakers themselves.
“Our goal, in my
opinion, should be not a quick fix. We can do it rapidly — but not a
quick fix,” said Sen. Lamar Alexander (R-Tenn.). “We want a long-term
solution that lowers costs.”
Sen.
Rob Portman (R-Ohio) warned his colleagues that the estimated budget
savings from repealing Obamacare — which Republicans say could approach a
half-trillion dollars — would be needed to fund the costs of setting up
a replacement. “This is going to be what we’ll need to be able to move
to that transition,” he said.
Rep.
Pete Sessions (R-Tex.) worried that one idea floated by Republicans — a
refundable tax credit — would not work for middle-class families that
cannot afford to prepay their premiums and wait for a tax refund.
Republicans
have also discussed the idea of generating revenue for their plan by
taking aim at deductions that allow most Americans to get health
insurance through their employers without paying extra taxes on it. Sen.
Bill Cassidy (R-La.), who has drafted his own bill to reform the
Affordable Care Act, said in response, “It sounds like we are going to
be raising taxes on the middle class in order to pay for these new
credits.”
Rep. Kevin Brady (R-Tex.), who
chairs a key tax-writing subcommittee, countered, “I don’t see it that
way,” adding that there is “a tax break on employer-sponsored health
care and nowhere else” equal to $3.6 trillion over 10 years.
“Could
you unlock just a small portion at the top to be able to give that
freedom [to self-employed Americans]? That is the question,” Brady said.
Rep.
John Faso (R-N.Y.), a freshman congressman from the Hudson Valley,
warned strongly against using the repeal of the ACA to also defund
Planned Parenthood. “We are just walking into a gigantic political trap
if we go down this path of sticking Planned Parenthood in the health
insurance bill,” he said. “If you want to do it somewhere else, I have
no problem, but I think we are creating a political minefield for
ourselves — House and Senate.”
The concerns of
rank-and-file lawmakers appeared to be at odds with key congressional
leaders and Andrew Bremberg, a top domestic policy adviser to Trump, who
have laid out plans to repeal the ACA using a fast-track legislative
process and executive actions from the administration. However, these
leaders acknowledged in Thursday’s meeting, as they have before, that
Obamacare cannot be fully undone — or replaced — without Democratic
cooperation.
That
and other aspects of the unfinished GOP plan prompted several wary
lawmakers to urge their leaders to move more deliberately — even as the
Trump administration appears to be moving ahead with repeal. Thursday,
the White House ordered federal health officials to immediately halt all
advertising and other outreach activities for the critical final days
in which Americans can sign up for 2017 health coverage through
Affordable Care Act marketplaces.
House Speaker Paul D. Ryan (R-Wis.) dismissed the concerns aired in the meeting during an interview at a Politico event Friday.
“We
have a responsibility to work for the people that put us in office,” he
said. “That’s the oath we take: to defend the Constitution, to fight
for the people we represent, and this is a fiasco that needs to be
fixed.”
Of
particular concern to some Republican lawmakers was a plan to use the
budget reconciliation process — which requires only a simple majority
vote — to repeal the existing law, while still needing a
filibuster-proof vote of 60 in the Senate to enact a replacement.
“The
fact is, we cannot repeal Obamacare through reconciliation,” McClintock
said. “We need to understand exactly: What does that reconciliation
market look like? And I haven’t heard the answer yet.”
Several
important policy areas appeared unsettled. While the chairmen of key
committees sketched out various proposals, they did not have a clear
plan for how to keep markets viable while requiring insurers to cover
everyone who seeks insurance.
At
one point Cassidy, a physician who co-founded a community health clinic
in Baton Rouge to serve the uninsured, asked the panelists a “simple
question”: Will states have the ability to maintain the expanded
Medicaid rolls provided for under the ACA, which now provide coverage
for more than 10 million Americans, and can other states do similar
expansions?
“These are decisions we haven’t made yet,” said House Energy and Commerce Committee Chairman Greg Walden (R-Ore.).
Rep. Tom MacArthur (R-N.J.) worried that the plans under GOP consideration could eviscerate coverage for the roughly 20 million Americans
now covered through state and federal marketplaces and the law’s
Medicaid expansion: “We’re telling those people that we’re not going to
pull the rug out from under them, and if we do this too fast, we are in
fact going to pull the rug out from under them.”
Republicans
are also still wrestling with whether Obamacare’s taxes can be
immediately repealed, a priority for many conservatives, or whether that
revenue will be needed to fund a transition period.
And
there seems to be little consensus on whether to pursue a major
overhaul of Medicaid — converting it from an open-ended entitlement that
costs federal and state governments $500 billion a year to a fixed
block grant. Trump and his top aides, including counselor Kellyanne
Conway, have publicly endorsed that idea. But doing so would mean that
some low-income Americans would not be automatically covered by a
program that currently covers 70 million Americans.
Many
of the concerns aired Thursday were more political than
policy-oriented. Faso’s remarks about Planned Parenthood generated tepid
applause. Ryan said this month that he expects the House to pursue the organization’s defunding in the reconciliation bill.
Those
expressing qualms included some of the top congressional leaders who
are in line to draft the health-care legislation. Alexander, for one, is
chairman of the Senate Health, Education, Labor and Pensions Committee.
Ryan
and other leaders have said they intend to pursue a piecemeal approach,
following the reconciliation bill with smaller ones that address
discrete aspects of reform.
Bremberg, chairman
of Trump’s domestic policy council, offered little detail in the
session about particular executive actions the Trump administration
intends to take or what legislative proposals the new president favors.
Instead,
he pointed to the executive order Trump signed last week, his first, as
proof of his commitment to undoing Obamacare’s mandates and said his
choice of Rep. Tom Price (R-Ga.) to be his health and human services
secretary “should speak volumes to people trying to understand what he’s
hoping to achieve.”
“This is not a
technocrat,” Bremberg said. “This is an experienced, compassionate
doctor who has experienced the health-care system firsthand and who has
been a leader here in Washington trying to address the policy reforms
that need to take place. Having both of those in a secretary is going to
be very important and very powerful.”
Even as
Bremberg offered few details about what the president plans to do, he
emphasized that last week’s executive order “repeatedly” used phrases
“such as ‘to the maximum extent permitted by law’ ” to enable his
political appointees to start dismantling the ACA by executive
authority.
“I’m sure many of us have been very
concerned about the interpretation of that phrase in the last six or so
years,” Bremberg quipped, referring to the previous administration.
“The president has now officially given direction [not only] to HHS, but
to all of these agencies that have responsibility . . . to exercise all
available discretion to begin helping the American people and to begin
fixing our health-care system.”
The White House did not immediately respond to a request for comment on Bremberg’s remarks.
Faso warned that by defunding Planned Parenthood in the reconciliation bill, “we are arming our enemy in this debate.”
“To
me, us taking retribution on Planned Parenthood is kind of morally akin
to what Lois Lerner and Obama and the IRS did against tea party
groups,” he said, a reference to accusations that the Internal Revenue
Service improperly targeted conservative political groups for audits.
Faso
continued: “Health insurance is going to be tough enough for us to deal
with without having millions of people on social media come to Planned
Parenthood’s defense and sending hundreds of thousands of new donors to
the Democratic Senate and Democratic congressional campaign committees.
So I would just urge us to rethink this.”
Robert Costa, Juliet Eilperin and Paul Kane contributed to this report.
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