As President-elect Donald Trump and congressional Republicans begin a perilous drive to overhaul the nation’s health care system, the gravity of dismantling the Affordable Care Act and devising a politically acceptable replacement is beginning to sink in with GOP lawmakers and many of those who voted for Trump.
Trump blithely asserted recently on CBS’s 60 Minutes that he and his allies on Capitol Hill will be able to simultaneously repeal and replace Obamacare early next year without wreaking havoc on the 20 million or more Americans who currently get their health care insurance through the program. However, senior House and Senate Republicans said this week that it could take as long as two to three years to hammer out a bipartisan replacement plan that could muster the necessary majorities in the House and Senate.
Prominent GOP lawmakers including House Majority Leader Kevin McCarthy of California, Senate Majority Whip John Cornyn of Texas and Sen. Lamar Alexander of Tennessee, the chair of the Senate Health, Education and Labor Committee, told reporters that reaching consensus on a replacement plan without stripping millions of Americans of the security of health care insurance will take a number of years to achieve.
“We’re talking about a three-year transition now that we actually have a president who is likely to sign the repeal into law,” Cornyn told reporters Wednesday, according to Politico. “People are being, understandably cautious, to make sure nobody’s dropped through the cracks.”
McCarthy told reporters on Tuesday that once Obamacare is repealed and the consequences begin to sink in, that “you will have hopefully fewer people playing politics” and more policymakers in both parties willing to come together to write replacement legislation. He added that when there is a “date certain” that Obamacare will disappear, “you know you have to have something done.”
Joseph Antos, a health care expert with the conservative-leaning American Enterprise Institute, said on Thursday that Republican leaders may be kidding themselves if they think they can get by with an open-ended deadline or replacing the Affordable Care Act.
“In the end, a two or three-year timeline is the same as saying nothing will ever happen,” he said in an interview. “In my view, they have a year. If they don’t pass a replace plan by let’s say December of 2017, then I think the reasonable view of Democrats in the Senate will be, well, they couldn’t get their act together, so why should we think we should help them?”
But if the Republicans could manage to both repeal and replace Obamacare within a year or so, he added, “That’s serious. It shows they really are going to do something. It matters.”
Repealing Obamacare will be the easy part for Republicans who are tentatively targeting mid-January for action, right around the time that Trump takes the oath of office as president. The Republicans already had a dress rehearsal for such action last January, when the GOP-controlled House and Senate used arcane “reconciliation” budget rules to ram repeal legislation through Congress and send it to the president’s desk. President Obama vetoed the legislation, but Trump is certain to sign a similar bill when it reaches his desk in the Oval Office.
The Republicans won’t need a single Democratic vote to accomplish their reprise of the Obamacare repeal legislation, which provided for a two-year wait before implementation. But crafting a replacement for the Affordable Care Act is a much different challenge and one that will require the acquiescence of some Democrats in order to achieve a needed 60-vote “super majority” to pass major legislation in the Senate.
The Republicans are far from agreeing among themselves on the details of new Trumpcare legislation to succeed Obamacare. House Speaker Paul Ryan (R-WI) has outlined an alternative in his “Better Way” proposals and House Budget Committee Chair Tom Price (R-GA), who has been chosen by Trump to become Secretary of Health and Human Services, has prepared a very detailed free-market style plan.
Trump has said that he is inclined to keep the “good parts” of Obamacare, including provisions that allow parents to keep their children on their health care policies until they turn 26 and a ban on insurance companies denying coverage to consumers with pre-existing chronic health problems. But beyond that, the Republicans’ approach to replacing Obamacare is very much a work in progress.
Although a new Kaiser Family Foundation tracking survey shows that the public is still divided over Obamacare, many of the ACA’s major provisions continue to be quite popular with people, even across party lines. Moreover, while half of those who voted for Trump favor repealing the law, the public more generally is more divided over the issue. Just a quarter of the voters surveyed since the election favor repealing the entire law, while 17 percent would scale it back, 30 percent would expand it and 19 percent would leave it as it is.
It took Obama, the Democrats and special interest groups nearly two years to forge a compromise on the current health insurance program before it was passed and signed into law in March 2010. Because of the size of their majorities in the Senate and House in 2010, the Democrats were able to pass Obamacare without a single Republican vote. However, the Republicans won’t have that luxury and will likely need at least eight or nine Democrats to join with them.
Republicans have spent so many years bashing Obama and his Democratic allies for the many shortcomings in the Affordable Care Act – especially numerous technical problems with its online insurance exchanges, soaring premiums and out-of-pocket costs, and the collapse of nearly two dozen non-profit cooperatives – that Democrats are likely to relish the GOP’s challenges and headaches in finally offering a serious alternative of their own.
Ryan, Senate Majority Leader Mitch McConnell (R-KY), Price and other GOP leaders will be challenged to assemble a coalition including the insurance industry, hospitals and doctors, the pharmaceutical industry, consumer advocates and others who will be needed to assure passage of new legislation. “We know that to correct [Obamacare] is going to take some time, it’s just that simple,” Senate Finance Committee Chair Orrin Hatch (R-UT), told The Washington Post.
However, Senate Democratic Leader Chuck Schumer of New York and other Democrats appear to be enjoying the Republicans’ discomfort as they inherit responsibility for Obamacare and other major health care programs including Medicare and Medicaid. Already there have been reports that UnitedHealthcare, Aetna, Blue Cross-Blue Shield and other major insurers are likely to accelerate their withdrawal from the Obamacare program over the next year or two as uncertainty grows over the program’s fate.
As the Republicans begin to wade into the political quagmire of health care, Schumer likened it to “the dog that caught the bus.” Now that they essentially own health care policy, Republicans may face voter resentment and backlash in the 2018 mid-term elections.
“They’re stuck and that’s why they don’t have a solution,” he told reporters.