WASHINGTON ― With Republicans finally realizing how complicated it may be to repeal and replace Obamacare, lawmakers are waiting to see if President Donald Trump will get out in front of an Obamacare repeal and replace plan, or whether he’ll sit back and blame Republicans when efforts fail.
Lawmakers are looking to Trump’s address to Congress Tuesday night for guidance and clues. If, for example, Trump were to say something like, “Send me a bill to repeal Obamacare,” Republicans may interpret that as a signal of Trump’s passive role in all of this, that he’s relying on House Speaker Paul Ryan (R-Wis.) and other Republicans to write the legislation and get it passed. If Trump exhorts Republicans to pass his own repeal and replace plan, opposing that legislation may be more difficult.
“I know from my constituents back home, if the president is in support of it ― my district is a 68 percent Trump district ― if the president’s in support of it, that gives them a certain comfort level,” Rep. Morgan Griffith (R-Va.) told The Huffington Post Monday night.
“Hearing from the president on whatever his plan might be, or if he’s endorsing this plan, I think those are important factors,” Griffith added.
Conservatives like Griffith have, thus far, panned the GOP draft replacement legislation that leaked last week.
“What is conservative about a new entitlement program and a new tax increase?” House Freedom Caucus Chairman Mark Meadows said Monday, adding that he and his group of roughly 40 conservative members couldn’t support that bill.
Rep. Mark Walker (R-N.C.), the Chairman of the Republican Study Committee ― a group of nearly 170 Republicans who are less interested in voting as a bloc but still hold considerable sway ― also said Monday that there were “serious problems” with the draft plan. “In that form and absent substantial changes, I cannot vote for the bill and, in good conscience, cannot recommend RSC Members vote for it either,” Walker said.
Those obvious problems led the Republican in charge of counting votes in the House, Majority Whip Steve Scalise (R-La.), to tell reporters on Tuesday that the bill which leaked to the press was “no longer a viable draft that we’re working off of.”
One of the big objections conservatives have with the leaked draft is its inclusion of “refundable” tax credits. Refundable tax credits are available to people who don’t make enough money to pay income taxes get the value of the tax credit as a direct subsidy, which, under the Affordable Care Act, goes directly to insurers to discount premiums. The leaked GOP alternative also had refundable credits, though the formula for calculating them was different and they are significantly less valuable, especially for low- and middle-income people.
House conservatives say that would simply mean swapping one entitlement for another ― and, in a sense, that’s correct. But without refundable credits, millions of lower-income people now getting Affordable Care Act coverage would end up uninsured, producing the kind of deep coverage losses that less extreme conservative lawmakers in the House, and especially the Senate, would find difficult to stomach.
So with Republicans abandoning their first draft and going back to the drawing board, questions about whether the next draft will rely on those refundable tax credits ― and whose repeal and replace plan this next draft will be ― have never been more pressing.
Trump told governors on Monday that he was coming up with his own plan, though it’s unclear if he’s actually doing that or if he’s just planning on claiming congressional Republicans’ plan as his own.
Republicans ultimately believe they will all share in the fate of an Obamacare repeal and replacement, but there are real questions and major implications if this is branded as “the Ryan replacement” or “TrumpCare.”
One thing to watch is how much Ryan embraces attaching his own name to these efforts. If Ryan’s pushing Trump to take ownership, and is distancing himself, it may be because he sees the pitfalls in actually passing the legislation, or trying to pass it and failing.
Conservatives, however, see the question of whose fault it would be if Republicans failed to repeal Obamacare as a matter of who stands in the way of Republicans putting up the 2015 repeal bill.
“Whoever doesn’t do the 2015 repeal owns it,” Rep. Dave Brat (R-Va.) said. “Because we voted yes on that.”
The House Freedom Caucus recently took an official position that they would oppose any repeal that wasn’t as aggressive as that 2015 reconciliation bill. There are doubts whether such a bill could pass now, as that bill gutted the Medicaid expansion, which is popular among a number of governors and GOP moderates. But the idea from conservatives is that moderates already voted for that repeal language, and thus, if they opposed it now, a repeal failure would be their fault.
Of course, moderates may look at the ultimatum conservatives are handing the GOP and blame them.
The truth is, to some degree, every Republican will whatever repeal plan is proposed. Even if Trump tries to put it all on Ryan ― or vice versa ― there will be plenty of blame to go around if Republicans fail to repeal Obamacare, or perhaps worse, are successful and don’t provide an adequate replacement.
One of Trump’s top congressional surrogates, Rep. Chris Collins (R-N.Y.) told HuffPost that Republicans should jointly own the effort.
“We should call it, ‘The GOP repeal,’” he said.
He added that it was on all Republicans to repeal and replace Obamacare, and that there would be consequences in the midterms if Republicans were unable to do it.
“Something’s going to hit the floor. If it doesn’t pass, I don’t know what Plan B is, but I would find it hard to believe that we’re not going to put something on the floor,” Collins said. “And, at some point, Paul Ryan, and Kevin McCarthy and Steve Scalise are going to have to round up the votes.”
GOP leadership always knew the tough part about a health care overhaul was the replacement: gutting the law was supposed to be easy. Republicans have voted on repealing part of Obamacare, or the entire thing, more than 60 times.
But when Trump announced that a repeal and replace should be simultaneous ― “probably the same day, could be the same hour” ― it foiled a key part of leadership’s plan to push a repeal through quickly and then sort out replacement details later.
Trump now has the ability to soften his stance on that timeline, which could be crucial to actually accomplishing at least the first part of their plan. But Trump also has the power to continue his “lead from behind” legislative strategy and watch the battle to repeal and replace Obamacare go up in smoke.
Some Republicans may quietly be cheering for such an outcome ― Trump himself has said he’s thought it could be politically beneficial to let Obamacare fail and force Democrats to work with him down the road ― but there is a large swath of conservatives looking at this first fight as the test of whether Republicans will follow through on their rhetoric.
“What our leadership needs to remember is that we lost our majority because we forgot who we were,” Rep. Raul Labrador (R-Idaho) said Monday night. “And if we forget once again the promises that we made to the American people and vote for a plan that is nothing more than Obamacare-lite, or RyanCare, I think they’re going to kick us out of office again.”
Jonathan Cohn and Jeffrey Young contributed to this report.