Republicans won the first skirmish in the Obamacare fight Wednesday, voting to begin debating fast-track budget procedures that, if successful, would allow the GOP to kill the 2010 health care law without having to face a Democratic filibuster in the Senate.
The 51-48 vote, on the second day of the 115th Congress, underscores how serious Republicans are in making good on their repeal pledge. But it also signaled that Democrats are just as committed to defending the Affordable Care Act and convinced that they have the upper hand politically.
After years of fruitless repeal votes, Republicans, now in control of Congress and about to take the White House, is firing with live rounds. Democrats said that means Republicans will take the blame for any mistakes.
“They want to repeal it and blame it on us. Not going to happen,” Senate Minority Leader Charles E. Schumer, New York Democrat, said after a Capitol Hill summit with President Obama.
The president urged congressional Democrats to defend his signature law even after he is out of the White House.
Republicans counterpunched by huddling with Vice President-elect Mike Pence on Capitol Hill to plot their strategy for repealing the law, which has been their top target ever since it was enacted.
“We are going to be in the promise-keeping business, and the first order of business is to keep our promise to repeal Obamacare and replace it with the kind of health care reform that will lower the cost of health insurance without growing the size of government,” Mr. Pence said.
Obamacare promised to reshape the U.S. insurance system by offering massive government subsidies to draw people into the market, hoping younger, healthier customers would keep costs low.
Instead, many healthy people resisted joining, the administration fell short of enrollment projections, and insurance companies responded by raising premiums and cutting their offerings.
That has left customers on Obamacare’s exchanges facing fewer choices and higher costs. Republicans are counting on those stumbles to convince voters that they are better off without the law.
“Americans are struggling. The law is failing while we speak. We need to reverse the damage that has been done,” said House Speaker Paul D. Ryan, Wisconsin Republican.
His election-year blueprint said age-based tax credits and market-oriented reforms should replace Obamacare’s heavy mandates and coverage requirements.
Democrats argue that the law is working for some 20 million Americans who stand to lose coverage if Obamacare is repealed.
“It’s a very different story to take something away from someone,” said House Minority Leader Nancy Pelosi, California Democrat.
The Obama administration said Wednesday that enrollments on the federal Obamacare website continued to outpace last year’s season — 8.6 million people selected plans through Dec. 31, compared with 8.4 million. Returning customers outnumbered new ones by 3-to-1, however, underscoring the difficulty of reaching holdouts who remain uninsured.
Republicans say they are working on a plan that will prevent major disruptions during the transition to a post-Obamacare system.
Mr. Pence said part of that likely will involve White House executive actions by Donald Trump, though he didn’t indicate what the moves would entail.
“We’re working on a strategy in concert with the leadership of the House and the Senate for both a legislative and executive action agenda to ensure that an orderly and smooth transition to a market-based health care reform system is achieved,” Mr. Pence said.
The Senate vote Wednesday was the first step in what will be a long path to repeal, stretching out over months. The budget will have to get final approval in the Senate and then in the House. After that, several committees will have to come up with specific legislation to repeal the Affordable Care Act, and that legislation will have to come back to the floors of both chambers for final votes.
The vote also showed how little margin of error Republicans have. Every Democrat present in the chamber voted against proceeding to the budget — as did Sen. Rand Paul of Kentucky, who is among a handful of Republican lawmakers expressing concerns about going into the repeal fight without a replacement in hand.
Policy analysts say insurers might flee Obamacare’s politically doomed exchanges if Republicans take too long to replace it and don’t offer an adequate fail-safe in the meantime.
Republicans are “in a position of great opportunity, but also of great political peril,” said Lanhee J. Chen, a fellow at Stanford University’s Hoover Institution who advised party nominee Mitt Romney on health care policy during the 2012 presidential campaign.
Indeed, Americans tell pollsters they are dissatisfied with Obamacare, but there is little consensus on what to do about it. Some want more government control over the health care market — the approach favored by Democrats — while others want more market forces unleashed.
Mr. Trump, who attacked Obamacare during the presidential campaign and promised a repeal, said Wednesday that Republicans need to tread carefully lest they end up owning the collapsing health care law.
“The Dems own the failed ObamaCare disaster, with its poor coverage and massive premium increases,” he said in a series of Twitter posts. “Don’t let the Schumer clowns out of this web … massive increases of ObamaCare will take place this year and Dems are to blame for the mess. It will fall of its own weight — be careful!”
That message appeared to be reaching rank-and-file members as they streamed out of the meeting with Mr. Pence.
Rep. Chris Collins, New York Republican and an early supporter of Mr. Trump, said the party will use committee markups to build consensus around a plan. He said Democrats failed to do that in 2010, when they muscled their law through Congress without a single Republican vote.
“We’re going to do it right. They did it wrong,” he said. “They, the Democrats, own the disaster called Obamacare, and we’re going to do it the right way.”
Republicans, who hold 52 Senate seats, are banking on Democrats to work with them to cobble together the 60 votes needed to overcome any filibuster of an Obamacare replacement bill.
Mr. Schumer said any problems in the health care system over the past few years have been blamed on Obamacare. Now, he said, Republicans will take the blame and shouldn’t count on much help.
“They’re going to have far more trouble than they ever imagined,” he said.