Anxiety about repealing Obamacare without a replacement got a lot more visible in the U.S. Senate on Monday evening, as a half-dozen Republican senators called publicly for slowing down the process.
It’s not clear how strongly these senators feel about it, or whether they are willing to defy party leadership over how and when efforts to repeal Obamacare proceed.
But at least three other GOP senators have now expressed reservations about eliminating the Affordable Care Act without first settling on an alternative. That brings the total to nine ― well more than the three defections it would take to deprive Republicans of the majority they would likely need to get repeal through Congress. And the restlessness isn’t confined to the Senate. Members of the House Freedom Caucus on Monday evening issued their own call for slowing down the repeal process.
At the very least, these developments suggest that taking President Barack Obama’s signature domestic policy off the books is unlikely to go as smoothly or as quickly as GOP leaders once hoped.
The change in the political environment has been perceptible, and relatively sudden. Following the election of Donald Trump in November, GOP leaders indicated they intended to move immediately on Obamacare repeal, using expedited procedures reserved for certain fiscal issues.
First, Congress would pass a budget resolution, instructing committees with jurisdiction over health care to write repeal legislation. Once that work was done, the House and Senate each would vote on the legislation, work out their differences, and send a bill to the White House, where Trump would presumably sign it.
The budget resolution is supposed to pass this week, and, as written, it calls for the committees to finish their work by Jan. 27 ― just a little more than two weeks from now.
But as the prospect of repealing Obamacare has suddenly ceased to be hypothetical, Republicans have confronted all sorts of questions ― not least among them what will happen to the roughly 20 million people getting insurance through the program right now.
Initially, GOP leaders responded by promising to let elements of Obamacare remain in place for a short time, setting up a transition period during which people who have Obamacare coverage would theoretically get to keep it. But over the past few days, several GOP senators have said that this “repeal-and-delay” strategy still leaves too much uncertainty about what would follow Obamacare, and have called for settling on a replacement plan ― or at least the outlines of one ― before voting on repeal.
On Monday, five of them put their protests on paper ― by introducing an amendment to the budget resolution that would push back that Jan. 27 date until March 3.
“Repeal and replace should take place simultaneously, and this amendment will give the incoming administration more time to outline its priorities,” Sen. Bob Corker (R-Tenn.) said. “By exercising due diligence we can create a stable transition to an open health care marketplace that provides far greater choice and more affordable plans for the American people.”
The four other GOP senators behind the amendment are Bill Cassidy (La.), Susan Collins (Maine), Rob Portman (Ohio), and Lisa Murkowski (Alaska).
As a legal matter, the amendment wouldn’t mean much. Neither the old nor the new deadline would be binding, Capitol Hill aides said, and it’s entirely possible that Monday’s statement will prove an empty gesture.
Nor is it likely that one extra month would give Republicans enough time to settle on an Obamacare replacement.
But the decision to propose the amendment ― and to attach strong quotes to it ― could also indicate something more, as Jim Manley, longtime aide to former Sen. Harry Reid (D-Nev.) and before that the late Sen. Edward Kennedy (D-Mass.), told The Huffington Post.
“The senators on this letter are smart enough to realize that the train is about to leave to station when it comes to repealing Obamacare without any alternative,” Manley said. “And they want to slow down the process by offering this amendment before the legislative process starts spiraling out of control.
“This letter is yet the latest indication that at least some Republicans realize that just simply repealing Obamacare without any viable alternative in place is completely unworkable and unrealistic and maybe just a little bit crazy,” Manley said.
The other big development on Monday was a statement from Sen. Lamar Alexander (R-Tenn.). According to Talking Points Memo, Alexander said, “We have to take each part of it and consider what it would take to create a new and better alternative and then begin to create that alternative, and once it’s available to the American people, then we can finally repeal Obamacare.”
It’s difficult to know how far Alexander or other Republican senators are willing to go on slowing Obamacare repeal, particularly if they face intense pressure from party leaders and conservative activists.
Shortly after the election, for example, Alexander said that Republicans needed to put their replacement together before going forward with repeal. “What we need to focus on first is what we would replace it with and what are the steps we would take to do that,” he told reporters on Nov. 17. “I imagine [it] will take several years to completely make that sort of transition to make sure we do no harm, create a good health care system that everyone has access to and we repeal the parts of Obamacare that need to be repealed.”
But after Senate Leader Mitch McConnell (R-Ky.) indicated that repeal would include a transition period, Alexander got in line. “The American people expect us to” repeal, he told reporters in the Capitol on Dec. 1, endorsing the repeal and delay strategy. “I think Senator McConnell wants to make it an early item. And the important thing to emphasize is it’s just a beginning. ... We want to start immediately, but it’ll take a matter of years to fully replace and rebuild the health care system that it has taken six years to damage.”
Alexander’s new statements would appear to suggest he’s still not comfortable with moving quickly. And that’s critical, given the role he would play in any Obamacare repeal effort, as a senior, widely respected member of the caucus ― and, more important, as chairman of the Health, Education, Labor and Pensions Committee, which has direct jurisdiction over health care legislation.
The reticence about junking Obamacare too hastily reflects certain realities that the GOP hasn’t really confronted until now. Different elements of the party have wildly different perspectives on what a new system should look like. And delivering the kind of financial protection most Americans want without dramatically reducing the number of people with insurance is going to be difficult, if not impossible, without the kind of federal spending most Republicans oppose.
Two senators proposing the budget amendment touched on those concerns. Cassidy, who is a physician, spoke specifically about the needs of people with serious medical problems ― the type of people who, in the years before Obamacare, could sometimes be denied coverage because of pre-existing conditions, or would run up against lifetime limits on benefits.
“As Obamacare is repealed and replaced, we must always keep in mind the mom with a breast lump who cannot afford Obamacare and wants something better but also needs to maintain her coverage,” Cassidy said. “This amendment will ensure adequate time is given to repeal Obamacare AND replace it with a substantive alternative that will work for her.”
Murkowski focused on importance making insurance widely available: “I remain committed to repealing the Affordable Care Act,” she said, “and I am equally committed to ensuring that all Alaskans and Americans, especially the most vulnerable among us and those in rural communities, have access to affordable, quality health care.”
Repealing Obamacare was a top priority for Trump during his campaign, and his call thrilled the millions of voters who say they are angry about the law. But Trump also vowed that “everybody has got to be covered,” which is not a promise that GOP leaders like House Speaker Paul Ryan (R-Wis.) have endorsed.
Although polls have consistently shown pluralities of Americans disapprove of the law, those same polls have shown that most of its elements ― including not just protections for people with pre-existing conditions, but also tax credits for buying insurance ― to be highly popular.
Senate Republicans have seen those polls, just as they have heard from GOP governors in states that have expanded Medicaid eligibility using funding that Obamacare made available. Those governors, among them Gov. John Kasich (R-Ohio), have said that it’s important to make sure Republicans have an alternative ready to go before getting rid of Obamacare.
Meanwhile, three other GOP senators ― Tom Cotton (Ark.), John McCain (Ariz.), and Rand Paul (Ky.) ― have expressed reservations about repeal without a replacement, albeit for different reasons.
How Trump feels about all of this remains something of a mystery. On Monday evening, he and his advisers huddled with Capitol Hill Republicans over several matters. Afterwards, in response to a reporter’s question about the specifics of repealing and replacing Obamacare, Trump adviser Steve Bannon said they were “still thinking that through.”
UPDATE: Jan. 10 ― A tenth Republican senator, Ron Johnson of Wisconsin, told NPR Tuesday afternoon that Republicans shouldn’t repeal the Affordable Care Act, but should “repair” it instead ― a line of reasoning that would likely be supported by an overwhelming majority of the country.
Johnson was asked if Obamacare should be officially repealed while a replacement was worked out. “We’re certainly not going to blow up the market and pull the rug out from under people and leave people high and dry,” he said. “If you had a bridge that’s about ready to collapse, the first thing you would do is you would start working to repair that bridge ... so people can use it while you start building the other bridges. It’s not a bad analogy. We’re talking about a broken system here. Let’s shore up that bridge, let’s repair that damage, while we start working on the bridges, and it may be multiple bridges.”
Trump, meanwhile, told The New York Times that after repeal, “the replace will be very quickly or simultaneously, very shortly thereafter.”
That undercuts the effort by House Speaker Paul Ryan. “Long to me would be weeks,” Trump said. “It won’t be repeal and then two years later go in with another plan.”
CORRECTION: Due to an editing oversight, this article previously misidentified Paul Ryan as a representative of Ohio.