GOP leaders look to early health care bill, details vague

Posted 5:48 p.m. Thursday
Updated 5:50 p.m. Thursday

FILE - In this Jan. 4, 2017 file photo, Senate Majority Leader Mitch McConnell of Ky. pauses during a news conference on Capitol Hill in Washington. The Republican-led Senate is poised to take a step forward on dismantling President Barack Obama’s health care law despite anxiety among some GOP senators that they still haven’t come up with an alternative. (AP Photo/Cliff Owen, File)

— Under mounting pressure from Donald Trump and rank-and-file Republicans, congressional leaders are talking increasingly about chiseling an early bill that dismantles President Barack Obama's health care law and begins to supplant it with their own vision of how the nation's $3 trillion-a-year medical system should work.

Yet even as Republicans said they will pursue their paramount 2017 goal aggressively, leaders left plenty of wiggle room Thursday about exactly what they will do. Their caution underscored persistent divisions over how to recraft a law they've tried erasing since its 2010 enactment, plus their desire to avoid panicking the 20 million people who've gained coverage under Obama's overhaul or unsettling health insurance markets.

In an interview with conservative radio host Mike Gallagher, House Speaker Paul Ryan, R-Wis., said the initial repeal and replace legislation will be "the primary part of our health care policy" and would be followed by other bills. Later, he told reporters at the Capitol that while Republicans will work quickly, "We're not holding hard deadlines, only because we want to get it right."

Senate Majority Leader Mitch McConnell, R-Ky., said the early repeal bill would "begin to make important progress." He said Republicans "plan to take on the replacement challenge in manageable pieces, with step-by-step reforms." He set no timetable.

"Repealing and replacing Obamacare is a big challenge. It isn't going to be easy," McConnell added.

The leaders spoke a day before the House plans to give final approval to a budget that would shield the forthcoming repeal-and-replace bill from a Democratic filibuster in the Senate.

Stripping Democrats of their ability to endlessly delay that bill — a tactic that takes 60 votes to thwart — is crucial for Republicans, who have just a 52-48 edge in the Senate. That chamber approved the budget early Thursday by a near party-line 51-48 vote, drawing a Twitter thumbs-up from Trump.

"Congrats to the Senate for taking the first step to #RepealObamacare — now it's onto the House!" the president-elect tweeted.

Trump, who enters the White House next Friday, has pressed Republicans in recent days to act quickly on annulling and reshaping Obama's law. GOP leaders seem to be taking his urgings to heart, though some have suggested his desire for speed doesn't match Congress' vintage lack of agility.

Asked how quickly lawmakers could send Trump a bill, No. 2 Senate Republican leader John Cornyn of Texas said, "The most important thing is when do you get 218 votes in the House and 51 votes in the Senate," the majorities needed for passage.

"He's not a creature of this place so there's always a bit of a learning curve," said the No. 3 Senate GOP leader, John Thune of South Dakota.

Obama's law, which he considers a trophy of his soon-to-end presidency, has provided health care subsidies and Medicaid coverage for millions who don't get insurance at work. It has required insurers to cover certain services like family planning and people who are already ill, and curbed rates the sick and elderly can be charged.

GOP leaders hope to use their first bill to void and rewrite as much of Obama's law as they can, but so far they've provided little detail. Cornyn said in a brief interview Wednesday that the early legislation will "push some of the responsibility and resources down to the states and give them more flexibility," such as for Medicaid.

Republicans want to end the fines that enforce the statute's requirements that many individuals buy coverage and that larger companies provide it to workers — mandates that experts say were needed to stabilize insurers' rates. They'd like to expand health savings accounts, erase the taxes Obama's statute imposed on higher-income people and the health care industry, eliminate its subsidies that help people buy policies and pare back its Medicaid expansion.

But they face internal disagreements over policy, such as how to pay for their new statute and how to protect consumers and insurers during what may be a two- or three-year phase-out of Obama's overhaul.

They also must heed Senate rules forbidding provisions that don't directly affect taxes and spending from being safeguarded from filibusters. That means repealing important parts of the law — like the requirement that insurers offer coverage to all customers including the most ill — would have to await later bills that would need Democratic support.

Democrats have so far solidly opposed the GOP effort. But one influential conservative health care authority warned Republicans Thursday that it would be best to work with their rivals.

"Bipartisan support for whatever is assembled is the best way, and probably the only way, to ensure that what passes in 2017 is accepted by the public" in a way Obama's law was not, James Capretta, a fellow at the American Enterprise Institute who formerly worked for President George W. Bush, wrote Thursday in National Review Online.


AP Congressional Correspondent Erica Werner and reporter Andrew Taylor contributed to this report.


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  • Pete Muller Jan 12, 3:06 p.m.
    user avatar

    In 2008 Mc Connell was the first to claim that the senate's main job is to have Obama fail. And that is how he behaved. By now the ACA could be a great way to insure the people who do not have employer sponsored health insurance. In fact, by now congress and the president could be working to not only reduce health insurance costs, but also actual health care costs, where the real meat is. But Mc Connell chose to go all opposition and waste our money with bogus repeal bills that got vetoed. Now he wants to repeal the ACA without having worked out a viable alternative.

  • Roy Abel Jan 12, 1:42 p.m.
    user avatar

    Yeah Pete, who's your provider? Before the individual mandate my premium was $259 per month, it's now $533 a month and if I am forced to go to an ACA compliant plan it will be $1077 per that from before you say it my current plan is not one of those "sub par" plans, the only thing I'll get going ACA is dental/vision for kids I don't have and maternity care.....don't need that either.

  • Anna Temple Jan 12, 1:32 p.m.
    user avatar

    That sounds like great insurance Mr Stark, My experience has been more like Pete's when it comes to annual increases in the double digits. Who is your provider Mr Stark, and how was your coverage? Although mine is expensive it is a very good plan. There are many providers that will sell you a plan that really covers very little and is of little value. But I think the ACA exposed those pay day lender types for the cons they are.

  • Pete Muller Jan 12, 1:04 p.m.
    user avatar

    Under Bush my health insurance costs went up between 7 and 12% annually for six years in a row while simultaneously reducing covered services. In the first year of Obama care ER visits actually went up but a higher number of ER visits were paid by insurances and not left to the general public to cover. Also, thank our GA in NC and the now ex governor Mc Crory who refused to have state exchanges built for greater competition. In states with more intelligent leadership, insurance costs inrceased significantly less than in NC.

  • Thom Stark Jan 12, 11:35 a.m.
    user avatar

    Who do you get your insurance from Pete? I paid $172 for a family of four before Obamacare, and never had double digit increases. Plus my deductibles were low. I now pay $392 for my family with increased deductibles. That over a 100% increase. Further the amount of people in emergency rooms without insurance never decreased. If anything it increased out of frustration with using the ineffectual Obamacare system. Ask Wake Med how many people owe them money, since Obamacare implementation. How can people owe them money if we are all covered by insurance? People never left the ER's.

    Plus, for Patriots the best thing for government to do most of the time is nothing. Especially when you have a leader that RULES instead of governs to the detriment of the American ideal. I applaud McConnell's stubbornness these past 8 years. I will admit though, and people need to understand this, if ACA is repealed do not expect premiums to go down. Health insurers are despicable beasts.

  • Pete Muller Jan 12, 10:47 a.m.
    user avatar

    Great news. McConnell can step back into the spot light. After 8 years of doing nothing of value, he can bring back relief to the American people by throwing 20 million of them under the bus. I got so tired of the increased wait times caused by newly insured people at doctors offices. Let's send them back to the ERs for the most expensive primary care in the world and go back to double digit percent health insurance premium increases we so happily embraced during the Bush years.

  • Thom Stark Jan 12, 8:30 a.m.
    user avatar

    This is great news. BUT! Do not expect insurer carriers to lower their premiums. They have now taken that money from the American public and they are not giving it back. They will come up with some story to justify their actions. Now that would be a story worthy of investigative journalism.