Democrats insisted Monday that five years in, Obamacare is as healthy and successful as they hoped, even as it remains a political drag and as Republicans prepared for yet another assault in this week’s budget votes.
House Minority Leader Nancy Pelosi, who will rally with fellow Democrats on Tuesday to commemorate the law, said 16 million Americans have gained coverage thanks to the Affordable Care Act, while the Obama administration said the law has saved hospitals $7.4 billion they would otherwise have spent on uninsured patients.
“Yet House Republicans continue their obsession with destroying this law and the health security it is providing millions and millions of American families,” Mrs. Pelosi said.
Congressional Republicans said the milestone is nothing to celebrate. The law remains unpopular, they said, and Americans are paying more and losing their doctors while taxpayers and businesses grapple with insurance mandates and penalties.
Republican leaders said they are prepared this week to pass budget resolutions that call for the law’s repeal.
“By passing a balanced budget that’s about the future, we can leave Obamacare’s higher costs and broken promises where they belong — in the past — and start fresh, with real health reform,” Senate Majority Leader Mitch McConnell said.
Freshmen Republican senators spoke up, too, saying voters sent a message in November to roll back the law.
“When this class was elected to the 114th Congress, the people of this country were sending a strong message that the prescription for Obamacare has expired,” said Sen. Cory Gardner, Colorado Republican. “And it’s time that we do something about it.”
The partisan rhetoric spotlighted the ill will that still surrounds Obamacare. It also kicked off a pivotal week for the Republican majority Congress, which must pass its budget plans before it can use an arcane budget procedure to bypass a Democratic filibuster in the Senate and get a repeal bill on President Obama’s desk.
Just as important for the Republicans is tackling Medicare’s payment formula and reauthorizing the Children’s Health Insurance Program, both of which face looming deadlines.
A deal struck by House Speaker John A. Boehner and Mrs. Pelosi would repeal a budget tool designed to limit payments to doctors who treat Medicare patients, known as the sustainable growth rate.
Congress regularly overrides the cuts, but top Democrats and Republicans said it’s time to scrap them permanently before April 1, when doctors face a 21 percent cut in reimbursements.
Some conservative Republicans are conflicted over replacing the sustainable growth rate, which was designed to control the federal deficit, without coming up with other offsetting cuts elsewhere. The bill would boost spending over the next decade by about $200 billion, but Congress would pay for only about $70 billion, according to initial estimates.
“The major sticking point is not every dollar is offset,” said Rep. Michael Burgess, Texas Republican and key advocate for sustainable growth rate repeal. “On the other hand, we talk all the time about entitlement reform. You can’t have an entitlement reform discussion until you deal with the sustainable growth rate.”
The growth rate debate will get wrapped up in broader budget politics this week.
House and Senate Republicans have written plans that cut more than $5 trillion in spending over the next decade, although the House version takes a more radical approach to Medicare by proposing a voucher-type program for beneficiaries starting in 2024.
Rep. Chris Van Hollen of Maryland outlined a Democratic alternative Monday that would raise taxes, preserve Obamacare and avoid tough cuts to Medicare or safety net programs, while spending more on education and transportation.
It would never bring the federal budget into balance, however.
Congressional budgets are blueprints without the force of law, but they offer a comprehensive outline of each party’s agenda as lawmakers forge actual spending bills.
This year’s process hands Republicans a coveted path to putting an Obamacare repeal bill on Mr. Obama’s desk. But the procedure, known as “reconciliation,” requires both chambers to agree on a compromise budget resolution and then pass legislation carrying out the budget’s instructions.
Reconciliation is a powerful tool because it avoids a Democratic filibuster — though Mr. Obama could still wield his veto against it.