Senate and House Democratic leaders are optimistic that they can block the GOP’s move to repeal and replace the beleaguered Affordable Care Act (ACA).
During a meeting with reporters at the National Press Club Monday afternoon, Senate Minority Leader Chuck Schumer of New York and House Minority Leader Nancy Pelosi of California claimed that the Republicans had lost their momentum following a week of angry protests at town hall meetings and marches throughout the country in opposition to dismantling Obamacare.
While it is still too soon to say with certainty, Schumer and Pelosi said there are strong indications that GOP congressional leaders will not be able to muster even a simple majority in the Senate necessary to pass their legislation and send it to President Trump for his signature.
“Republicans have not been able to pick off a single Democrat to support any of their plans,” Schumer said. “We have shown a united front, while the Republicans’ internecine warfare has been on full display. I believe the odds are very high we will keep the ACA. It will not be repealed.”
Trump, Senate Majority Leader Mitch McConnell (R-KY), House Speaker Paul Ryan (R-WI) and other GOP leaders sought to rally governors, health insurance executives and others during meetings at the White House yesterday around the broad strokes of a plan that would replace Obamacare by 2018.
They reiterated their claim that Obamacare is in a “death spiral” because of soaring premiums, shrinking policy choices and more and more major insurers like Humana, Aetna and Blue Cross & Blue Shield pulling out of the ACA government-subsidized insurance market because of heavy losses. “Obamacare is a disaster and it’s only getting worse,” the president said. Ryan, meanwhile, told reporters outside the White House that “We’re going to give people choice and freedom, and that’s what a patient-centered health care system does.”
Ryan, a former House Budget Committee chair and policy wonk, has taken the lead in designing a GOP replacement plan that would repeal most of the ACA’s mandates, income-based tax subsidies and business and personal tax increases necessary to finance the program. He would replace them with a more market-oriented approach, including refundable, age-based tax credits to help cover premiums that would provide more assistance to older, wealthier Americans than younger, poorer consumers.
Ryan’s plan would also encourage the use of tax-exempt medical savings accounts, provide older, sicker people with coverage through state-operated “high risk pools” and gradually phase out expanded Medicaid coverage for low-income people. It would also convert the traditional Medicaid program for 74 million low income people to block grants to the states to help control costs and limit the availability of coverage.
However, Ryan’s plan is just one of many circulating on Capitol Hill and at the White House. And as time begins to run out for the Republicans to pull together and pass an approach that garners widespread support within the party, Trump spent part of the weekend conferring with Republican governors John Kasich of Ohio, Scott Walker of Wisconsin and Rick Scott of Florida on various alternative plans they have been promoting.
Kasich has proposed scaling back but not repealing some of the ACA’s more generous benefits -- including reducing the number services that insurers must provide in individual policies and tightening eligibility requirements. But like many of the other Republican governors whose states opted for expanded Medicaid, Kasich doesn’t want to see his constituents lose those hard-won and vital benefits.
By yesterday, the president voiced surprise at how difficult and complicated it is to draft a new health care plan – something former President Barack Obama and a Democratic majority spent the better part of two years trying to do before Congress passed the Affordable Care Act in 2010 – without the help of a single Republican.
“Nobody knew that health care could be so complicated,” Trump said yesterday. He once again ruminated on how much easier it would be if he and the Republicans simply stepped back and allowed the ACA to collapse of its own weight, instead of rolling up their sleeves and jumping into the fray. In that way, he said, the Democrats would have to take all the blame while he and the Republicans could escape political responsibility in the 2018 mid-term election.
"Let it be a disaster, because we can blame that on the Dems that are in our room -- and we can blame that on the Democrats and President Obama," Trump said in remarks to the National Governors Association. "But we have to do what's right, because Obamacare is a failed disaster."
Trump and the Republicans have a lot riding on success in passing budget reconciliation legislation that repeals major portions of Obamacare and replaces it with GOP-designed alternative within the next month or so – well past their original Jan. 27 deadline for pulling the legislation together. Trump on several different occasions told reporters that his administration was within days of unveiling replacement legislation that would simultaneously repeal and replace Obamacare, but each time the deadline slipped by.
In a sign of the Republicans mounting desperation, the Wall Street Journal reported on Monday that Republican leaders have concluded their best chance is to “set a bill in motion” and then gamble that rank and file members will conclude they have no choice but to support it. This “now or never” approach to force GOP lawmakers into line has been tried in the past by Democratic and Republican leaders with mixed success.
If they prevail in repealing Obamacare, then the Republicans will be on a roll, and some Democrats may have no choice but to join with them to fine tune replacement legislation that would do the least damage to their constituents. Refusing to join in would invariably mark their party as naysayers unwilling to address what most observers agree are serious flaws in the health insurance program.
But if they gamble and lose, Trump and the Republicans would suffer a humiliating setback that would be hard to explain away to their political base, after the Republicans gained control of the White House and both chambers of Congress.
Because Republicans hold a narrow 52 to 48 seat majority in the Senate, it would take the defection of just three moderate Republicans to block legislation dismantling Obamacare from passing, even under special budget reconciliation rules Senate Majority Leader Mitch McConnell (R-KY) and Ryan intend to use in both chambers to prevent a Democratic filibuster.
Already, a few Republicans including Sens. Susan Collins of Maine, Lisa Murkowski of Alaska, Bob Corker of Tennessee and Bill Cassidy of Louisiana have raised strong objections to some of the leading GOP replacement proposals, especially those that would phase out expanded Medicaid coverage in 31 states and the District of Columbia or cut funding for Planned Parenthood – which would be called for in Ryan’s plan.
Pelosi and the Democrats would have a much steeper climb in trying to block the repeal of Obamacare in the House, where the Republicans hold a 247 to 188 seat advantage and GOP lawmakers for years have been promoting legislation to kill the healthcare program. However, the House Republican caucus is badly divided over how to proceed.
For one things, many of the 35 members of the arch conservative Freedom Caucus are demanding a complete repeal of Obamacare, expanded Medicaid and the taxes used to fund the program as the price for their support. But others are determined to preserve expanded Medicaid for low income people in their districts as well as some of the other more popular features of Obamacare.
“Don’t underestimate the power of Medicaid,” Pelosi said in assessing the Democrats’ chances of blocking action in the House.