Senate Minority Leader Chuck Schumer (D-N.Y.) was reduced Wednesday to complaining that President-Elect Donald Trump and congressional Republicans would “Make America Sick Again” if they follow through with promises to repeal Obamacare.
But even though Democrats control neither chamber of Congress, and lost the White House, they will not be powerless to cause headaches for Republicans trying to move on from the Affordable Care Act. The GOP plans votes early this year to repeal Obama’s health care reform law, but some experts contend that Democrats will still be able to stymie Republicans on key provisions.
“The meaning of that ‘incidental’ is going to be huge over the next few years.”
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Republicans will need only simple majorities in the House of Representatives and the Senate to overturn parts of the law that are substantially related to budget. Measures that are only “incidental” to the budget will need a filibuster-proof 60 votes in the Senate.
“The meaning of that ‘incidental’ is going to be huge over the next few years,” said Josh Blackman, a professor at South Texas College of Law in Houston and an expert on the Affordable Care Act.
Initially, it would be up to the Senate parliamentarian to determine which measures need 60 votes and which need only 51. The Republicans could overrule the parliamentarian with a simple majority, but Blackman said GOP senators might be reluctant to set a precedent that Democrats might use in the future.
“The question is: How far are Republicans willing to alter the scale of reconciliation?” he said.
A likely outcome is that Republicans could sweep away the taxes and subsidies under Obamacare. But they might be stuck with the regulations and mandates that hamstring insurance companies.
“Insurers would pull out immediately,” said Gary Claxton, vice president of the Kaiser Family Foundation.
Many of the insurance regulations, such as provisions limiting premium cost differentials based on age and protection for people with pre-existing medical conditions, would continue to apply to insurance companies whether they participated in the health exchanges or not.
“The insurance companies would freak out because they won’t be able to underwrite policies in that environment,” Blackman said.
Republicans Promise Bold Action
Vice President-Elect Mike Pence and Republican leaders in both chambers said during Capitol Hill news conferences Wednesday that they would move aggressively to repeal the law. A resolution to do so already has been introduced in the Senate. Congressional leaders said implementation of the repeal would be delayed for a while to give people time to adjust.
House Speaker Paul Ryan (R-Wis.) said he hopes for a “stable transition” to a health system that offers more choices, more patient control, and more freedom.
“The [current] law is failing as we speak,” he told reporters.
Democrats interpret an unwillingness to implement an immediate change as proof that Republicans have no viable alternative.
“They’re like the dog that caught the bus,” Schumer told reporters. “They can repeal, but they have nothing to put in its place. That means so many good things go away.”
Trump tweeted that “Republicans must be careful” in designing a replacement for the Affordable Care Act. He has said he wants to keep some aspects of the law and preserve Medicare.
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Pence said Trump is prepared to act unilaterally if necessary.
“We’re working right now, the [incoming] White House staff is, on a series of executive orders that will enable that orderly transition to take place even as Congress appropriately debates alternatives to and replacement of Obamacare,” he said.
Grace-Marie Turner, president of the free market Galen Institute, said the initial vote to repeal was only the first step of a long process.
“In order to do this properly — and Speaker Ryan has said we’re going to follow regular procedure — it’s going to take time to do this right,” Turner said.
Obamacare’s Dwindling Choices
Turner said Congress needs to create a safety net without handcuffing a free market that will improve quality and constrain costs. Rapidly rising prices have hurt consumers, while in 1,022 counties, consumers signing up for the health care exchange can buy from only one company.
“That’s not a choice,” she said. “That’s not affordable.”
Sens. Mike Lee (R-Utah), Marco Rubio (R-Fla.), and Ted Cruz (R-Texas) sent a letter to Senate leaders Wednesday urging a vote to repeal Obamacare in the first weeks of the new Congress.
“We understand that this will require first moving a budget resolution for fiscal year 2017 through Congress,” the letter states. “While we recognize this budget resolution is primarily a mechanism to advance repeal, it should still contain transparent spending and revenue numbers and include all extant enforcement tools.”
The conservative Republican Study Committee plans to introduce its own bill later Wednesday. Jack Minor, a spokesman for the group’s chairman, Rep. Congressman Mark Walker (R-N.C.), told LifeZette that Walker understands that some transition time will be needed. But he added in an email that Walker favors setting a hard limit on that delay period.
Claxton, the Kaiser vice president, predicted Republicans ultimately will come up with a long-term plan.
“Eventually, something will happen,” he said. “It may take a while. And I don’t think Republicans yet know what they will do.”
Blackman said Schumer and the rest of the Democratic caucus have no incentive to help Republicans. He said congressional leaders will have to confront the reality that will be impossible to keep the popular parts of Obamacare — such as letting young adults stay on their parents’ plans and requiring insurers to cover people with pre-existing medical conditions — without forcing someone to pay for them.
Whatever they do, Blackman said, time is of the essence.
“Every day, Republicans are less popular because now, they’re in power,” he said.