Congress was poised to start major work this week on dismantling the Affordable Care Act, but conservatives are already fuming over lost momentum that they fear could doom the repeal effort.
Lawmakers missed a non-binding deadline to deliver details of a repeal plan Friday and left a GOP retreat without reaching consensus on a replacement package that an increasing number of Republicans want to see agreed before the 2010 law is taken apart.
Complicating the effort, Congress is struggling to find its footing with an unpredictable administration whose actions in only one week have distracted from what lawmakers thought was the top item on the Republican agenda. Indeed, with President Donald Trump’s immigration order causing chaos at airports and drawing global condemnation of what is seen by many as a U.S. ban on Muslims, GOP lawmakers could have a hard time remaining focused on the ACA.
And some conservatives worry that delay could be costly, perhaps even fatal, sapping lawmakers’ drive to repeal and sidelining the effort in the face of other priorities, such as keeping the federal government running.
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“Right now you are seeing the question of replace stopping the momentum of repeal,” said James Wallner, a former Senate aide and group vice president for research at the Heritage Foundation. “Before you know it, you are into the late summer or fall because you have to do stuff like funding the government, and you haven’t done (repeal) yet. You can see very quickly how you end up in a place where you’re just trying to shore up the existing system.”
According to a Reuters report, Wall Street portfolio managers are already betting against full repeal. They cite congressional gridlock and expect instead a modified version of the law known as Obamacare, which insures an estimated 20 million Americans, many of whom previously lacked health coverage.
“The moment they agreed to have a replace, they may have lost the issue,” said Brian Darling, a senior vice president at Third Dimension Strategies and Sen. Rand Paul’s former senior communications director. “Ultimately when you get hung up on the idea of replacing, it gives leadership an excuse to do nothing.”
But former House Speaker Newt Gingrich, an on-again, off-again adviser to Trump, insisted Congress will not get sidetracked with Trump at the top.
“It is inevitable that it will be replaced,” Gingrich said of the Affordable Care Act.
“There is a very deep awareness, which the president has emphasized, that you cannot leave 23 million people worried about their health insurance,” Gingrich said. “You can’t just repeal with a vacuum and you go from the Democrats owning it to us owning it. Why should we rush in to own their problem?”
Scott Jennings, political director for former President George W. Bush, said Sunday that Republicans can’t afford to put health care “on the backburner,” though it may get less news coverage because of what he called "hysteria" over the vetting order as thousands of American protested in cities and at airports around the country.
Republicans promised their constituents a speedy repeal of the law in each of the last four elections, warned Tim Phillips, president of the Koch Brothers-backed Americans for Prosperity.
“This is a significant undertaking, rolling back the largest entitlement expansion since the 1960s era. It’s a big undertaking and you want to get it right,” Phillips said. “The leadership and rank and file understand what’s at stake. They understand just how deep the disappointment and dismay would be from millions of activists who worked so hard to give them a majority in the House and Senate and then the presidency.”
House Speaker Paul Ryan has outlined an ambitious 200-day agenda that calls for delivering repeal and replace legislation to Trump’s desk by late March or early April. The measure that is currently funding the government expires at the end of April and will be a priority for lawmakers. So will repeal, Ryan pledged Friday.
“We have to move quickly but not at the expense of not getting it right,” Ryan said at a Politico Playbook interview.
Relevant House committees are expected to take votes within the next two weeks on draft legislation to repeal the law.
But finding compromise legislation to replace it remains a stumbling block, said Sally Pipes, president of the Pacific Research Institute and a former health care advisor to Rudy Giuliani’s presidential bid. Several members of Congress have plans, including Ryan, who offered a detailed blueprint last year of how he’d replace the 2010 law that required nearly everyone to obtain health insurance coverage.
“How can they get anything together when they have too many plans and everyone wants to take credit?” Pipes said. “Politicians when they’re elected, they need to do the tough things, right away, up front, otherwise it doesn’t happen.”
Trump has promised a health care plan that will offer “insurance for everybody” but few other details. Lawmakers had hoped for more clarity at the legislative retreat in Philadelphia, but he did not stick around for questions.
Many hope that once confirmed, Rep. Tom Price, Trump’s nominee for Health and Human Services Secretary, will play a leading role in helping shape legislation and identify action that he can take to help dismantle the law. The Senate Finance Committee is scheduled Tuesday to vote on Price’s nomination, although Democrats are now under pressure to slow confirmations after Trump’s latest round of executive orders.
Price offered lawmakers little guidance last week at his Senate Finance confirmation hearing, saying he would want to make certain “that every single American has access to affordable coverage.”
Lawmakers at the retreat in Philadelphia predicted the legislation would pass in sections: “You will not see a massive anti-Obamacare thing jammed through,” said Rep. Ted Budd, R-N.C.
“We’re probably going to be working into the night and over a couple of weekends to get it done,” added Rep. Mike Bost, R-Ill. “But we’ll get it done.”
Lawmakers are using a budget resolution that called for a repeal plan to be delivered to the White House by Jan. 27, but that deadline was widely viewed as a moving target.
The budget resolution only allows Congress to pull back the parts of the law that deal with spending or taxes. So further repeal and replacement would need another measure – one that could require 60 votes in the Senate, including from Democrats.
That could further fracture Republicans. Two Senate Republicans introduced legislation last week with hopes of securing Democratic support, but it does not repeal the taxes in the 2010 law that pay for many of the provisions in the law.
The plan offered by Sens. Bill Cassidy, R-La., and Susan Collins, R-Me., also allows states that want to keep the Affordable Care Act to do so.
Keeping the taxes is unlikely to appeal to many Republicans, Sen. Rand Paul, R-Ky., told reporters as he unveiled his own legislation. His Obamacare Replacement Act would eliminate the requirement that most Americans purchase insurance or pay a fine and authorize tax credits for individuals and families that contribute to health savings account.
And telling states “if you like Obamacare you can keep it is not a rallying cry that Republicans across the country are going to rally to,” Paul said.
Allowing states like California and New York to keep Affordable Care Act coverage through federal funding, would require states that don’t want Obamacare “to pay for New York and California’s Obamacare,” Paul said.
“Unraveling something on the books for seven years, it’s not easy,” said Sal Russo, a former advisor to Ronald Reagan aide and more recently chief strategist for the conservative Tea Party Express. “I have some sympathy for the argument that you can’t just repeal and let it hang there. The problem of repeal without replacement leaves a lot of uncertainty.”
Anita Kumar contributed to this report from Washington and Curtis Tate contributed reporting from Philadelphia.