Republicans used the first two weeks of the new Congress to pry open the door to Obamacare’s repeal, even before President-elect Donald Trump is sworn in.
But now the hard part begins, with GOP-led committees racing to draft legislation that dismantles President Obama’s politically maligned law, while following the famous doctors creed: Do no harm.
House Speaker Paul D. Ryan has assured skittish rank-and-file Republicans that GOP leaders and the incoming Trump administration are “in sync” on plans to shift from the Affordable Care Act to a plan that replaces heavy federal mandates with market-oriented reforms, though the party hasn’t put a replacement bill on paper.
The risky strategy has emboldened Democrats, who say their political rivals are jumping off a cliff without a safety net for 20 million people who gained coverage under Obamacare, which expanded Medicaid coverage for the poor in 31 states and doles out taxpayer-funded subsidies to qualified persons seeking private plans on web-based exchanges.
“They’re going to pull up every single person who lost insurance and put them on the nightly news, and be able to manipulate public opinion,” said Ford O’Connell, a GOP strategist.
So far Republicans leaders appear undeterred. They’re using a fast-track budget process to repeal and replace as much of the law as they can in the first several weeks of Mr. Trump’s administration. And they’re counting on the incoming president to issue administrative actions that smooth the transition away from Obamacare.
The House voted 227-198 on Friday to approve a 2017 budget that imposes a Jan. 27 deadline for a quartet of GOP-led committees to craft legislation that guts Mr. Obama’s law, while using arcane rules to avoid a Democratic filibuster in the Senate.
Nine Republicans balked at the GOP’s politically thorny plan during Friday’s roll call — the budget doesn’t balance, and the path forward on health care reform is unclear. Yet their defections weren’t nearly enough to tilt the vote, underscoring the GOP’s desire to fulfill its campaign promises of repeal.
The Senate approved the budget early Thursday on a 51-48 vote that brought in support from all but one Republican in the chamber, clearing the way for a repeal vote as soon as late February.
Mr. Ryan’s office says the budget vote was merely a first procedural step to begin the GOP’s “rescue mission” on health care, and that a postinaugural GOP retreat in Philadelphia will shed more light on the way forward.
Yet Democrats are plotting a vocal defense, saying repeal without a replacement could actually kill people and ripple through the economy, particularly in the health sector, as patients show up for medical care with no way to pay for it.
If the GOP has its way, “the American people will be screwed,” said Rep. Hakeem S. Jeffries, New York Democrat. “People in Michigan, Pennsylvania, Wisconsin, Ohio — screwed. Seniors in Florida — screwed. People on the West Coast and the East Coast — screwed. People in Appalachia and rural America — screwed.”
Democrats are also mobilizing the public. On Sunday thousands attended a rally in Detroit against the GOP’s health plans hosted by Sen. Bernard Sanders, Vermont independent and progressive hero. House Minority Leader Nancy Pelosi also attracted crowds at a San Francisco rally.
Mr. Obama and his party allies say Obamacare could be fixed by adding a government-run plan, or “public option,” to improve competition in the exchanges, or boosting the taxpayer-funded subsidies to entice more people to sign up.
GOP leaders have rejected both ideas as “more Obamacare.” Instead, their election-year blueprint would dole out age-based tax credits and unleash market forces to make coverage more attractive, while setting up high-risk pools to take care of sick customers who’ve been priced out of the individual insurance market.
They said insurance rates and deductibles are spiraling out of control under Obamacare, even as the number of companies offering plans in many counties is dwindling. A third of counties have just a single active insurer, the GOP says.
“My colleagues, this experiment has failed. This law is collapsing as we speak. And we have to step in before things get even worse,” Mr. Ryan said, marshaling his troops before Friday’s vote.
The speaker of the House rarely votes, but Mr. Ryan put himself on record in favor of the budget that paves the way for repeal, underscoring the magnitude of the effort.
Yet a mix of conservatives and GOP centrists voted “no,” citing concerns over spending or the way forward on health care: Reps. Justin Amash of Michigan, Charles W. Dent of Pennsylvania, Brian K. Fitzpatrick of Pennsylvania, John Katko of New York, Raul R. Labrador of Idaho, Walter B. Jones of North Carolina, Thomas MacArthur of New Jersey, Thomas Massie of Kentucky and Tom McClintock of California.
While there are no hard deadlines for replacing the law, Republicans say there will be a smooth transition to a GOP overhaul that will be vetted by Capitol Hill committees and moved in pieces, rather than one large bill.
Mr. Trump has egged them on, pressuring the party to repeal and replace Obamacare “essentially simultaneously” within weeks of his swearing in, though that timeline appears to be unrealistic.
Also, Senate Republicans, who hold 52 seats in the upper chamber, will need to win support from at least eight Democrats to overcome a filibuster of any legislative replacement.
As it stands, the parties are bitterly divided: No Democrats in either chamber voted for the budget that unlocks the door to repeal.
Senate Minority Leader Charles E. Schumer, New York Democrat, says Republicans are heading into a “boxed canyon” and should come to the negotiating table before it’s too late, and Democratic state leaders are piling on, saying the GOP should pump the brakes.
“Before you vote to repeal the ACA, every American has the right to know exactly what, if anything, you intend to replace it with,” California Insurance Commissioner Mike Jones wrote Thursday to House Majority Leader Kevin McCarthy. “A vote to repeal the ACA, without a specific replacement, would create crippling uncertainty, causing instability in the insurance market which could bring about the collapse of our health care system.”