POLITICO
By Jennifer Haberkorn
11/16/16 07:30 PM EST
Republicans on Capitol Hill are growing confident that they can begin to repeal Obamacare once President-elect Donald Trump is sworn in, along with a pledge to replace it later.
“We have an Obamacare emergency right now,” said Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate HELP Committee. “I think we could move forward in January on some aspects of repeal but we need to make sure that we are helping people and that we do no harm.”
Discussions among GOP lawmakers and with the Trump transition team are still taking shape. But the goal is to move aggressively, getting points on the board against President Barack Obama’s health care law right away — as early as Inauguration Day itself, Jan. 20.
The politics could be tricky — Republicans would be scrapping a law that covers 20 million people with no concrete alternative plan laid out. But after seven years of opposition, Republicans are anxious to prove that they’re doing what voters sent them and Trump to Washington to do: Kill the Affordable Care Act.
Plus, they question whether those 20 million Americans are really so happy with their health insurance under the ACA.
“I don’t have a lot of people in my district who are crying about the possibility of losing Obamacare. In fact, they’re cheering for it to go away,” said Rep. John Shimkus (R-Ill.), who is running to be chairman of the House Energy and Commerce Committee, which has jurisdiction over health care. “No one is banging on my door saying, ‘Save this program.’”
Republicans say repeal efforts will start in January. They are considering whether to swiftly repeal the biggest pieces of the law through a complex budget process called reconciliation that Democrats cannot block. If they go that route, Republicans would likely pass the repeal — but delay the effective date for a year or two until a replacement could theoretically be enacted. That would shield the GOP from an immediate backlash from taking away insurance. They are even considering passing the bill through Congress in early January so that Trump could have it on his desk within minutes of swearing the oath of office.
Alternatively, they might start by repealing some smaller but deeply unpopular parts of the law, such as the individual mandate.
“I don’t think we should take a lot of time,” said Sen. Orrin Hatch (R-Utah), chairman of the Senate Finance Committee. “We understand what the problems are and we know that Obamacare is a destructive force in America and almost everybody admits it.”
“It doesn’t work, it’s costing too much money, it isn’t evolving into better health care and we have to do something to straighten it out,” Hatch added.
The chairmen of the House and Senate Budget committees have informally signed off on a plan to do both a 2017 and 2018 budget early in the Trump administration. That would give the GOP two opportunities to enact legislation that doesn’t allow a filibuster. (The House Budget chairman, Rep. Tom Price of Georgia, is being considered for HHS secretary.)
At the same time, they expect the Trump administration to use its executive powers to immediately start to peel apart other pieces of the law. The Senate Republican Policy Committee on Wednesday circulated a document that said regulatory relief would come “on Day One” from the Trump administration’s Department of Health and Human Services.
“The original health care law itself was 2,700 pages, but there were also more than 40,000 pages of administrative rules, regulatory guidance, and even blog posts setting Obamacare policy,” they wrote. “A lot of this can be scaled back on Day One.”
So far, Democrats are pushing the GOP to produce a replacement plan, so they can try to show the public the differences between the two, and how they would affect those losing coverage.
“The first thing we have to do for the American people is we have to be honest with them about what he’s going to replace it with,” said Sen. Claire McCaskill (D-Mo.) “And let’s see how that would work for the millions of people who have certainty and security right now. You can’t repeal it until we know exactly what you’re going to replace it with and when that’s going to go into effect so obviously they have some work to do.”
That “20 million” argument is falling flat with Republicans.
“Most of those 20 million got bronze policies with a great big deductible and not much insurance, so I don’t know that there’s going to be a big backlash,” said Sen. Johnny Isakson (R-Ga.). “There are some minefields out there but we can deal with them.”
(In fact, most people on the exchanges chose silver plans, which provide a higher level of benefits.)
“People have crappy insurance now,” Shimkus said. “They have high costs, they have high deductibles, it’s like they don’t have insurance. So this fear that they’re going to lose something that they don’t think they have anyway is crazy.”
But there’s more than one kind of backlash. Obamacare-backers might object to repeal, but Republican voters would offer their own fierce objections if the new Congress didn’t dismantle the law.
As Rep. Michael Burgess (R-Texas) put it, they’d say, “We voted for [a Republican] House, Senate, White House and this thing is still there? Are you kidding me.”
Even those Republicans who want quick and decisive Obamacare action caution that getting it all done will take a while.
“We need immediate relief, we need to act quickly,” Alexander said. “But we may have to complete the repeal step by step because Obamacare was not passed with 51 votes; it was passed with 60 votes. And we’ll need 60 votes to finally change it.”