- The Washington Times - Monday, January 4, 2016

Congressional Republicans will kick off 2016 with a vote to repeal Obamacare, but they are still struggling to figure out the next steps in replacing President Obama’s health insurance overhaul, which, while suffering growing pains, now provides coverage to millions of Americans.

Already long overdue, the House GOP, led by new Speaker Paul D. Ryan, has vowed to unveil a plan this year to “replace every word of Obamacare.” His chief lieutenant, Majority Leader Kevin McCarthy, said Wednesday’s final vote on repeal is the first step toward that — even though Mr. Obama is certain to veto it.

“Passing and sending an Obamacare repeal to the president’s desk will set America up for a new patient-centered health care system that gives families the power over their health care decisions instead of Washington bureaucrats,” said Mr. McCarthy, California Republican.

Dating all the way back to House Republicans’ 2010 Pledge to America, GOP lawmakers have vowed to “repeal and replace” Obamacare. But while Congress has held dozens of failed votes on the “repeal,” the “replace” part has languished as Republicans fight internal battles over how much of a role the government should have, and whether they can realistically cancel health care that’s been extended to millions of Americans.

“Republicans’ claims about working on an alternative have always been nothing more than a talking point,” said Drew Hammill, spokesman for House Minority Leader Nancy Pelosi, California Democrat. “What is real is that their first week back in session in 2016, they will vote to take health care away from 22 million Americans.”

Former Secretary of State Hillary Clinton, the front-runner for the 2016 Democratic nomination for president, piled on Monday from the campaign trail in Iowa, saying “because they have no plan, the Republicans just want to undo what Democrats have fought for decades and what President Obama got accomplished.”

As unpopular as it is in polling, Mr. Obama’s health law has proved to have staying power even in places where Republicans have won elections promising changes.

Kentucky Gov. Matt Bevin, sworn in just last month, campaigned on a platform of undoing his Democratic predecessor’s efforts to implement Obamacare, including an expansion of Medicaid that’s added 400,000 residents to the federal-state insurance program for the poor.

Last week, however, Mr. Bevin switched gears and said instead of rejecting the expansion, he would seek a waiver from the federal government to allow him to attach GOP-favored reforms to Medicaid.

He’s following in the footsteps of Republicans in Arkansas, Iowa and Indiana, who each worked with the Obama administration to tailor the program’s expansion to their liking.

Analysts say Capitol Hill Republicans will struggle to ensure coverage for as many people as Obamacare does, given the GOP’s interest in cutting costs. That likely means any repeal would have to be gradual.

“It will be tough to replace all of it in one fell swoop. Millions now have ACA coverage of one kind or another. Anything [the GOP does] requires a phase in — probably several years,” said G. Terry Madonna, a politics professor at Franklin and Marshall College in Lancaster, Pennsylvania.

To that end, the repeal bill that passed the Senate last year and faces a final House vote this week would take a couple of years to roll back the law’s expansion of Medicaid and cut taxpayer subsidies that help pay for coverage for millions of customers who buy plans on the Obamacare exchanges.

The bill would also scrap Obamacare mandates that require Americans to obtain insurance and large employers to provide it, and it would strip federal funding from Planned Parenthood for one year as punishment for its abortion practice.

Republicans view the effort as a test run for actually repealing Obamacare with a party ally in the White House next year, after previous efforts to scrap the law ran into Democratic opposition in the Senate. This time GOP leaders used a fast-track process known as budget reconciliation to avoid a filibuster and get the bill through the Senate, 52 votes to 47, in early December.The House will approve Senate changes to the bill this week, dispatching an Obamacare repeal on Mr. Obama’s desk for the first time.

Mr. Ryan’s spokeswoman, AshLee Strong, said House Republicans will have a chance to game out their next steps during a conference retreat next week in Baltimore.

Several existing proposals hit on common themes, giving the GOP a head start. Among proposed reforms, Congress would dole out block grants that let states take control of how Medicaid dollars are spent, allow insurance companies to sell their product across state lines and provide tax credits that help low-income Americans buy insurance, but without mandating them to get covered.

“There are a lot of other ideas out there, but what all conservatives can agree on is this: We think government should encourage personal responsibility, not replace it,” Mr. Ryan, Wisconsin Republican, said in a December speech that outlined the House’s 2016 agenda.

“There are many things to do,” he said, “but most urgent is to repeal and replace Obamacare.”

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