Suddenly President-elect Donald Trump and some Republican congressional leaders are pulling in different directions in their drive to dismantle Obamacare.
While “repeal and replace” was a highly effective campaign slogan that helped the Republicans win the White House and retain control of the House and Senate, it has now become an albatross around the necks of the incoming president and Senate and House GOP leaders.
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No one really knows what repeal and replace actually means. Senate Majority Leader Mitch McConnell (R-KY), a major cheerleader for dismantling President Obama’s signature health insurance program, insists the way to go is to repeal the program with a lengthy transition period and then come back with a full blown replacement down the road.
But that’s not what Trump has in mind. Trump vowed during a press conference at Trump Tower on Wednesday to unveil proposals to repeal and then replace the Affordable Care Act literally within days or hours of each other by next month, after Rep. Tom Price (R-GA), his choice to head HHS, is confirmed by the Senate.
In the wee hours of Thursday morning, the Senate voted 51 to 48 to formally kick off the process of repealing Obamacare, with two Senate committees required to report back by Jan. 27 with specific language for gutting key provisions of the law, including taxes, premium subsidies and mandates on individuals and businesses. McConnell told reporters on Tuesday that his office will be working with Trump’s new Department of Health and Human Services officials to “craft the way forward” in replacing Obamacare – but that the “first step towards replacement is to repeal.”
“It will be essentially simultaneously,” Trump told reporters in New York. “It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day, could be the same hour … And we’re going to get a health bill passed. We’re going to get health care taken care of in this country.”
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Meanwhile, House Speaker Paul Ryan (R-WI) has gradually been inching towards Trump’s position, telling reporters earlier this week that Congress would do repeal and replace “concurrently,” rather than “simultaneously,” which would leave the lawmakers with a little more latitude in designing a comprehensive replacement. Ryan also said he was exploring options for including parts of a replacement plan in the budget reconciliation bill approved by the Senate and that awaits House action on Friday.
In a news conference on Capitol Hill today, the Speaker declared, “I’ve spoken with President-elect Trump probably two times in the last three days on this and [Vice President-elect] Mike Pence was in my office yesterday to discuss this, and we agree we want to make sure that we move these things concurrently, at the same time, repeal and replace.”
Timing is everything in politics, as the saying goes, and Congress and the incoming Trump administration may be on a collision course. If McConnell persuades lawmakers in both chambers to move full steam ahead on repealing Obamacare – with the understanding that a comprehensive GOP replacement would be dealt with later – Trump may be confronted with a repeal-now, replace-later bill on his desk in the Oval Office contrary to what he says he wants.
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The notion of Trump vetoing a bill dealing with Obamacare seems unthinkable at this point, although the president-elect has shown no reluctance to call out or challenge congressional Republicans when he disagrees with them. However, with Trump bearing down on Ryan and McConnell to make good quickly on his campaign pledge to repeal and replace the “disastrous” Obamacare program, the president-elect is more likely than not to get his way.
The idea once advanced by some veteran GOP lawmakers including Sen. Lamar Alexander of Tennessee, the chair of the Health, Education, Labor and Pensions Committee, and Finance Committee Chair Orrin Hatch of Utah that it might take another year or two to fashion a replacement plan now seems out of the question.
Yet, Trump, Ryan and McConnell are kidding themselves if they think any permutation of repeal and replace legislation they dream up will have smooth sailing through Congress. That’s especially true amid the growing unease among GOP lawmakers in both chambers about their party overplaying their hand, and in the process triggering a collapse of the health insurance market and stripping millions of Americans of their coverage in the coming year or two.
“Congressional Republicans are like the dog that finally caught the car,” said William Galston, a political scholar at the Brookings Institution and one-time domestic policy adviser to President Bill Clinton. “And the questions that they have tap-danced around for six years are now squarely on the front burner.”
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“Across party lines, health care experts are sending up rockets of alarm about this destabilization of the entire health care markets that could occur if there is a significant interval between the repeal and the replace,” he added today. “I think that President-elect Trump has much better political instincts than Mitch McConnell does. I think it’s increasingly clear that the momentum has shifted in favor of a much smaller gap between repeal and replace.”
Joseph Antos, a health care expert with the conservative-leaning American Enterprise Institute, said yesterday that Trump’s timetable for simultaneous action “seems impossible to me,” and that developing a complex replacement plan could take many months if the new president is serious about changing the law. Because Republicans are using special budget reconciliation rules to repeal Obamacare, McConnell needs to muster a simple majority of 51 votes to ram through repeal legislation.
McConnell was able just to muster 51 votes on Thursday to pass the preliminary budget action after Sen. Rand Paul (R-KY) sided with the Democrats in trying to stop the measure.
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However, those rules won’t apply when Congress must do the much more challenging task of drafting sweeping replacement legislation, which must be approved in the Senate by a 60-vote supermajority. When the time comes for that, McConnell will have to seek out a handful of moderate Democrats to push the replacement legislation through. That won’t be easy because Senate Democratic Leader Chuck Schumer of New York is unwilling to bail out the Republicans unless they agree to delay repeal while the two sides hash out a bipartisan compromise.
“It is more than possible for Trump and the Republicans to have a decent outline of the major themes of a replacement, but the idea of having a bill that is ready to go is out of the question,” Antos said in an interview. “That’s not just because of the complexity but because of the need for negotiations with Republicans first and then ultimately there will have to be negotiations with Democrats.”
“And all of those negotiations end up changing something or other,” he added.
