WASHINGTON ― Senate Republicans have not yet begun to work in earnest on a replacement plan for the Affordable Care Act, Sen. Bob Corker (R-Tenn.) said on Tuesday.
It was a rare public admission of what has become obvious from the outside, as Republicans find both the politics and the substance of Obamacare repeal more difficult in practice than in rhetoric. (Watch the video above, produced by J.M. Rieger, to see the problem as it unfolds over seven years.)
“To be honest, there’s not any real discussion taking place right now,” Corker told reporters in the Capitol.
He said nervous talk about the consequences of repeal were accurately captured by secret audio from last month’s Republican retreat in Philadelphia. The same fears were expressed in additional sessions that were not recorded, he said.
“At the retreat, which y’all unfortunately were able to listen to every word of ... we had breakout sessions where it was just the Senate talking about it, and you would have heard more of the same,” Corker said. “But the fact is we’re gonna end up covering people and we’re gonna end up granting flexibilities, but there’s gonna be a cost associated with it.”
Discussion at the retreat was captured on audio by an unknown person who sneaked into the room. The recording featured members of the House and Senate fretting about the political peril of repeal promises. According to Corker, the spy would’ve caught the same angst no matter where the recorder had been placed.
Asked when Republicans might get down to the business of crafting an Obamacare alternative, Corker said he wasn’t sure.
“I have no idea,” he said. “I’m not on a committee that deals with this ... but I don’t see any congealing around ideas yet. And I think it’s fine that we take our time. I thought the The Wall Street Journal editorial today was dead on. I mean, we’re dealing with something that is very important, very complicated. It’s explosive if not handled properly, and we should take our time and do it right.”
Some senators have taken steps to advance the Republican health care agenda. Senate Finance Committee Chairman Orrin Hatch (R-Utah) in 2015 co-sponsored a health care bill with Sen. Richard Burr (R-N.C.), working across the Capitol with Rep. Fred Upton (R-Mich.). Hatch could draw on that measure for his panel’s work in crafting a replacement.
Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) released an outline of policies he favors to transition from the Affordable Care Act to a new system, but he hasn’t actually detailed what the new system would look like. And other Republican senators, including Bill Cassidy (La.) and Susan Collins (Maine), have talked about new health care proposals.
Rather than show that the Senate GOP is on top of an Obamacare replacement, the existence of these various competing plans, which are at different levels of completeness, are instead a sign of how far Republicans are from a consensus on how to move forward ― the “congealing around ideas” Corker referred to. It also illustrates Corker’s observation that no one in the upper chamber is in charge of aligning the disparate efforts.
The House may be further along, but still is nowhere near agreement, despite promises from House Speaker Paul Ryan (R-Wis.) that Obamacare repeal and “replace” would be completed by year-end. He’s been promising a GOP plan for years.
One Republican congressman, asked Tuesday about replacement progress, suggested the question was better directed at “the big boys.”
Ryan has his own broad replacement outline, released last year but never written as legislation. Committees have begun holding hearings and writing small parts of whatever “replace” may turn out to be.
But there are other plans emerging from the House, including one from the conservative Republican Study Committee and another from Rep. Tom Price (R-Ga.), who Trump has named to be secretary of Health and Human Services. And, of course, Trump has made a lengthy string of contradictory statements about own his goals for the health care system, and has promised to release a proposal of his own after Price wins confirmation.
The flurry of uncoordinated activity ― and the inactivity Corker described ― on health care reform in the White House, the Senate and the House shows that Republicans now confront a reality Democrats acknowledged even before Barack Obama won the presidency in 2008 and led his party on the road to the Affordable Care Act.
Health care is complicated, and monkeying around with one-fifth of the economy will create winners and losers. The losers can get loud, and the winners can worry they might actually not wind up on the winning side.
In 2009 and 2010, Democrats gambled that the winners would sufficiently outnumber the losers to make reshaping the health care system worth it. And while public polling has found support for the Affordable Care Act tepid ― even with the recent upswing in the law’s ratings as repeal looms ― Democrats succeeded in significantly shrinking the ranks of the uninsured and reducing the rate of those who lack coverage to a historic low.
Republicans had it easier during the nearly seven years since the Affordable Care Act’s enactment. The opposition party could afford to focus solely on the losers, such as people paying more for their insurance under the ACA, and on the law’s shortcomings, like the high deductibles many policies carry.
Now that they’re in charge of the entire federal government and have the means to keep their promises to repeal the Affordable Care Act and “replace” it with something else, Republicans are awakening to the tradeoffs involved in eliminating coverage for as many as 30 million people, and to the difficulty of meeting the standards they themselves established for health care reform.
And unlike congressional Democrats and the Obama White House in 2009, Republicans haven’t laid groundwork with the powerful health care industry, including physicians, hospitals, health insurance companies, drugmakers and patient groups. That has the industry nervous, and leaves the GOP with a lot of work.
Trump’s vows to provide “much less expensive and much better” health care is at odds with the GOP agenda of eliminating the taxes that financed about half of the Affordable Care Act’s coverage expansion. It also contradicts the party’s opposition to regulatory mechanisms that require insurers to offer plans to anyone regardless of pre-existing conditions, to cover a core set of basic health services, and to provide full financial protection against very high costs by forbidding annual and lifetime benefits limits and capping patients’ out-of-pocket costs.
Repealing taxes is popular, but Corker warned that doing so sets up a perpetual trap for Republicans. “If you repeal the taxes on the front end and you end up with, say, a Medicaid expansion, or even if it winds up being refundable tax credits, you’re still expending dollars,” he said. “And if you repeal all the sources of income on the front end, then” ― Corker paused to emphasize the absurdity of the position ― “it’s difficult to me to see how you ever get to a place where you actually fund what you’re expending. And then you’ve self-created the doc-fix scenario, where each year it just keeps getting extended, you’re piling up the deficits, because I don’t see Republicans voting for a tax increase.
“That’s why to me it’s important that this happen simultaneously,” Corker said. “I don’t see a scenario where people are pushing to insure less people. You gotta have money to pay for that.”
Survey results will be posted here on Friday, Feb. 10. Matt Fuller and Jonathan Cohn contributed reporting. Sign up here to get Ryan Grim’s newsletter, Bad News.