- The Washington Times - Sunday, February 26, 2017

Congressional Republicans who spent seven years promising to repeal Obamacare now face a do-or-die stretch on Capitol Hill, hoping to build unity and take the first steps to repeal the health care law before they break for Easter.

After being heckled by liberal activists and constituents back home last week, Republican lawmakers return Monday to Washington facing a grim situation: Obamacare is more popular than ever, and unity within their own ranks is proving elusive.

Still, Republicans say they must deliver on their promise to voters to nix the 2010 Affordable Care Act, saying the law will collapse on its own without a repeal and consumers will be the ones who suffer.

Leaders have promised to introduce a bill by mid-March.

“We’re working hard on legislation to deliver relief from Obamacare’s skyrocketing costs and dwindling choices, restore state control, strengthen Americans’ access to care and reinvigorate the free market in health care,” said Rep. Kevin Brady, Texas Republican and chairman of the House Ways and Means Committee. “I’m confident the House will move forward with legislation to do just that in March.”

House Speaker Paul D. Ryan, Wisconsin Republican, said repeal legislation will be marked up once congressional budget scorekeepers vet the plan for its impact on things like spending, deficits and how many people would be covered.

Yet Republicans in the House Freedom Caucus — about 40 members who frequently clash with leadership — are worried about the overall cost of the effort and the use of refundable tax credits, saying it is an entitlement and they don’t want to usher in “Obamacare light.”

They are itching to scrap the health care law, however, and treat all states the same under Medicaid, particularly those that resisted the Obama administration’s monetary incentive.

Centrist Senate Republicans who represent expansion states will face pressure to safeguard the federal matching funds that enabled their states to cover tens of thousands of needy residents.

Robert Laszewski, a health care policy consultant in Alexandria, Virginia, said Republican leaders have “their work cut out for them” in fashioning a plan that suits every faction of their party and can attract eight Senate Democrats, whose votes will be needed to fully repeal and replace the law.

“If they can’t get the process of repeal and replace moving in the next few weeks, there is no reason to believe they will every be able to do it,” Mr. Laszewski said.

At the same time, he said, “Democratic arguments that Obamacare should be left alone because it is working will make them look foolish if they do not cooperate in a fix.”

A leaked draft of the House Republican plans, dated Feb. 10 and first reported by Politico, calls for replacing Obamacare’s health insurance exchanges and income-based subsidies with tax credits based on age starting in 2020, which would help those without insurance secure private coverage. A person 30 or younger would receive subsidies of about $2,000, while someone older than 60 would receive double that.

Republicans say it will allow people to pour more money into tax-advantaged savings accounts that can be used for medical expenses and phase out generous federal funding for states that opted to expand Medicaid, the insurance program for the poor.

Republicans then want to cap federal spending on Medicaid through per-capita limits or block grants, saying the program’s budget will balloon out of control without a change.

Gone is the unpopular “individual mandate” requiring people to hold insurance or pay a tax, which proved to be ineffective at driving young and healthy people into Obamacare’s exchanges in great enough numbers.

Instead, Republicans want to dole out “innovation grants” to states so they can decide whether to set up a high-risk pool or other programs to cover people with pre-existing conditions who have been priced out of the market. They would let insurers charge consumers more if they haven’t maintained continuous coverage — a way to prevent people from signing up only when they get sick and need to submit claims.

Republicans haven’t said how they will pay for their plans, though the draft proposes taxing a portion of more generous employer-sponsored health care plans. Economists say that’s a good idea, but it would rankle labor unions that fought Obamacare’s “Cadillac tax” on generous health care plans.

Democrats say the solution to Obamacare’s troubles is to inject more government support, including taxpayers’ money, to help the middle class buy coverage and offering a government-run plan, or “public option,” to compete with private plans.

Liberals also say public opinion is on their side, citing the furious backlash to Republicans at town hall meetings across the country.

A poll by the Kaiser Family Foundation said 48 percent of Americans have a favorable view of Obamacare, while 42 percent do not. It is the best outlook for the health care law since Kaiser started keeping track in 2010, and it is largely driven by an uptick among independents.

“It’s no wonder Republicans are getting an earful back home from constituents who want them to turn back from their dangerous plan to make America sick again,” said Senate Minority Leader Charles E. Schumer, New York Democrat.

• Tom Howell Jr. can be reached at thowell@washingtontimes.com.

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