Republicans Wrestle with Obamacare ‘Replace’ Strategy

GOP leaders agree on immediate ACA repeal but float different timing to pass, implement fixes

by Kathryn Blackhurst | Updated 10 Jan 2017 at 2:08 PM

President-Elect Donald Trump and many Republican members of Congress made skyrocketing premiums under the Affordable Care Act a key issue of their campaigns and largely agree the law should be repealed immediately. But the exact strategy and mechanisms the GOP will pursue to replace popular aspects of the law with improved legislation remain the subject of debate.

“Our legislating on Obamacare, our repealing and replacing and transition legislating will occur this year,” House Speaker Paul Ryan said during a press conference Dec. 4. “What date all of this will phase in on is something we do not know because we are waiting for the Trump administration … We are waiting for Tom Price to be confirmed and become the secretary of health and human services.”

“There are a few people who are calling for it to happen at the same time … they’re holding repeal hostage for their replace bill when I think they should both happen.”

“We want to make sure there is an orderly transition so that the rug is not pulled out from under the families who are currently struggling under Obamacare while we bring relief,” Ryan continued.

Kentucky Sen. Rand Paul proposes the GOP get “repeal and replace” done in one fell swoop. It’s an approach House Speaker Paul Ryan appears to favor.

“It is our goal to bring it all together concurrently,” Ryan said Tuesday to a group of reporters on Capitol Hill. “We’re going to use every tool at our disposal through legislation, through regulation, to bring replace concurrent along with repeal, so that we can save people from this mess.”

But while Ryan is signaling a preference for getting everything done at once, Senate Majority Leader Mitch McConnell has hinted the upper chamber will pursue a more piecemeal, delayed approach.

McConnell said Obamacare replacement measures would be passed "in manageable pieces" that look nothing like the massive "2,700-page" ACA legislation and its "accompanying thousands of pages of Obamacare-related regulations," in an op-ed published by Fox News Monday.

"The Senate is currently working to pass the legislative tools to bring relief to the middle class by repealing this partisan law," McConnell wrote. "That doesn't mean the law will end overnight. There will be a stable transition period, and once repeal is passed we will turn to replacement policies that cost less and work better than what we have now."

So what are the Republicans going to do?

Alyene Senger, a policy analyst in the Center for Health Policy Studies with The Heritage Foundation, recommends the Republican members of Congress begin by immediately repealing Obamacare by passing a 2015 "reconciliation" bill which would "repeal major chunks" of the legislation.

"So, certainly, you know, you can't repeal every piece of the law through reconciliation. The rules won't allow for that, but you can repeal the major parts — the Medicaid expansion, the exchange subsidies, and the 18 increased taxes," Senger told LifeZette. "So we think that repealing those provisions of the law is the best first step to getting to repeal the whole law and replacing it."

Senger expressed confidence that a GOP replacement would pass "very quickly" if Obamacare is repealed through the "reconciliation" bill.

"So, the repeal bill will include a delay of the repeal of those coverage provisions to allow for a smooth transition to whatever the replacement plan is," Senger said.

Senger also warned against Republicans attempting to "repeal and replace" the entire bill at the exact same time, saying that it would be "legislatively impossible because the reconciliation bill doesn't allow for a full replacement."

"There are a few people who are calling for it to happen at the same time ... they're holding repeal hostage for their replace bill when I think they should both happen. They just have to happen separately," Senger clarified. "We definitely think that they should happen soon after one another, but doing them at the same time isn't a requirement. And insisting upon that is actually going to hinder the repeal process. And given that Republicans have campaigned upon repealing for the last six years, they need to follow through on that."

Dr. Ramin Oskoui, a cardiologist named Physician of the Year in 2015 at Sibley Memorial Hospital, agreed Republicans should avoid the potential pitfall of trying to rush a comprehensive "repeal and replace" solution.

"Don't try to do it all — that's the way to madness, it can't be done, as the ACA proved," Oskoui noted. "Use a piecemeal strategy — slice the salami and make the other side seem unreasonable."

Oskoui warns Republican leaders in Congress to avoid "being short-sighted," and begin immediately implementing a variety of "cost-saving measures ... one at time."

If the Democratic minority obstinately votes against every reform the Republicans propose simply because the Republicans proposed it, that will reflect poorly on the Democrats, Oskoui said.

"If you win — then you've got those 'down' — you can defer the tough issues until next year —and at that time you either have the hard stuff done, or you have a great record of Dems obstructing 'commonsense reforms,'" Oskoui noted.

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