Congressional Republicans appear to have a new, fast-track timeline for repealing and replacing the Affordable Care Act that was outlined Wednesday on the first day of a three-day policy retreat in Philadelphia. Similar health-plan concepts by Paul Ryan and Tom Price, Trump's choice to head Health and Human Services, have been floated, but Senate democrats are unlikely to approve either one.
House Speaker Paul Ryan (R-WI) outlined a 200-day legislative game plan in which the Trump administration and Republican-controlled Congress would repeal and replace major elements of Obamacare by April, before turning their attention to major tax reform.
The first step will be to complete work on a budget reconciliation package in the next couple of weeks by repealing Obamacare and replacing key portions of it, according to media reports.
Then the really hard work begins when Republicans try to assemble a workable replacement plan that not only wins approval of GOP members but somehow attracts at least eight Democrats in the Senate whose votes will be needed to put it over the top.
Politico reported yesterday that Ryan had shared his timeline chart with President Donald Trump who gave it his rousing approval. The hard-charging new president promised to use the White House bully pulpit to help line up the needed votes in both chambers and quash opposition. Senate Majority Leader Mitch McConnell (R-KY), who faces a much tougher challenge than Ryan in driving a replacement plan through the Senate, reportedly is less sanguine.
For all the optimism emanating from the GOP’s policy retreat in Philly, it should be emphasized that congressional and presidential timelines have been known to frequently slip rather dramatically.
Trump, of course, boasted to The Washington Post ten days ago that he and his advisers were on the verge of completing an Obamacare replacement plan providing “insurance for everybody.” He promised he would soon unveil it with Ryan and McConnell at his side.
“It’s very much formulated down to the final strokes,” Trump told the newspaper. But we are still waiting to see that plan.
A half-dozen more moderate Republicans in the Senate, including Bob Corker of Tennessee and Susan Collins of Maine, cautioned earlier this month that the process of replacing the Affordable Care Act could be long and perilous and they urged caution.
Senator Lamar Alexander of Tennessee, the Republican chair of the health committee, indicated that the process of voting to just replace Obamacare likely would take until the summer to complete. After that, he said, “it’ll probably take two or three years to implement [a replacement] over time."
But after Trump cracked the whip and said voters won’t tolerate anything but a rapid, near simultaneous repeal and replace action, Alexander and the others fell into line. Just about every Republican on Capitol Hill is now talking about a fast-track approach to wrap things up this year so that consumers and insurers aren’t left in the lurch.
But whether anyone has a real handle on how this health care saga will play out remains to be seen.
What seems crystal clear at this point -- after more than six years of seeking the demise of the Affordable Care Act – is the Republicans are nowhere near a consensus on replacement legislation. The new Trump White House and congressional leaders appear to have plenty of random ideas for creating a more market-oriented, consumer friendly, less costly health insurance system.
There is plenty of talk about encouraging the interstate sale of insurance to encourage competition, more tax-exempt health savings accounts, refundable tax credits to help the rich and poor alike cover their premiums, “risk pools” for older and sicker insurance applicants and block granting Medicaid to cut costs and empower state officials.
Yet neither Trump nor Ryan nor McConnell can honestly point to an approach that would win the support of the health care, drug and insurance industries -- which must have buy-in -- as well as rank and file Republicans and their constituents throughout the country.
And the heat is on from Republican governors, hospital administrators and insurers who fear that Trump and the GOP are leading the country into a health care abyss. Practically every day now, someone is stepping forward with a possible solution that promptly gets shot down.
On Wednesday, for instance, Kentucky Sen. Rand Paul introduced the Obamacare Replacement Act, which he declared would create more affordable insurance plans, eliminate the gap between private and employer-sponsored care, and allow consumers to save unlimited amounts of money in health savings accounts, according to Morning Consult.
Earlier in the week, Collins and GOP Sen. Bill Cassidy of Louisiana unveiled a plan they hoped would bridge the vast political divide on Capitol Hill by allowing blue states that are happy with Obamacare to keep coverage as it is, while allowing other red states that want to repeal the law and its mandates to create an alternative program with 95 percent federal funding.
Critics on the right and the left both howled at the plan as being grossly inadequate, and Collins and Cassidy quickly retreated.
A spokesman for Collins insists that Collins and Cassidy were not in retreat, and noted that Sen. Lindsey Graham (R-SC) signed onto their proposal on Wednesday. “Our plan represents a growing coalescence of Republican ideas on health care while returning power to states and fulfilling President Trump’s pledge to bring health care coverage for all,” Cassidy said in a statement.
(This story was updated at 12:10 p.m. on Thursday, Jan. 26.)