House Republicans Posture On Obamacare Repeal

A Friday procedural vote to repeal Obamacare has Republicans from different corners of the House GOP conference ― leadership, conservatives and moderates ― all scrambling to position themselves for upcoming negotiations over the future of health care.

Leadership aides insist they feel good about this vote, which is the first step in eventually repealing the 2010 law. But this initial vote could still be threatened by a small group of conservatives, and an even smaller group of GOP moderates, insisting on additional details of what that eventual repeal would look like.

Republican leaders are pushing through these early repeal steps while revealing as little information as possible about what an Obamacare alternative would look like, knowing there’s far more agreement in the conference over getting rid of Obamacare than there is over what to replace it with. Even initial details of the repeal ― like when it would take effect, how much of Obamacare it would kill, and whether it would ultimately (as Speaker Paul Ryan has said) defund Planned Parenthood ― are being kept under tight wraps.

Which is why conservatives and moderates, united in their desire for more details but divided on what those details should look like, are trying to find out who is going to get rolled in the Obamacare repeal and, more importantly, the replacement.

Ryan insists those issues will be worked out in due time through committees. But Republicans know any legislation of this magnitude requires agreement at the top levels of the House, Senate and the White House, and some lawmakers are looking to use leadership’s need for votes on this first budget resolution as a way to extract concessions.

House Freedom Caucus Chairman Mark Meadows (R-N.C.) may have secured a big one on Thursday. Although Ryan said Thursday that he and President-elect Donald Trump are “in sync” on the timing of a repeal and a replace ― “essentially simultaneously,” in Trump’s words ― there’s quite a bit of open interpretation as to what that might mean. Part of that replacement could be the Health and Human Services secretary offering new guidance on health care, while the repeal resolution could also do small components of a health care alternative. Ryan has also said that a replacement wouldn’t be a “one and done bill kind of thing,” which would seem to belie the idea of a replacement immediately following repeal.

But Meadows told The Huffington Post Thursday night that Ryan committed to bringing a replacement within days of the repeal vote, not weeks.

If true, that would give House and Senate Republicans a pretty clear picture about what they’re voting for when they ultimately repeal the health care law. However, some House Republicans are hearing that a repeal would have a three-year delay until it’s enacted, which is more time than conservatives had wanted to give Obamacare.

While conservatives feel like they lose on that, GOP moderates might feel like they win. Those Republicans were looking like they could vote against this first budget resolution in significant numbers on Wednesday, but leaders seem to have quelled that rebellion for now. A source with knowledge of how those moderates were voting suggested that leadership now only expects around three or four defections ― Reps. Charlie Dent (R-Pa.), Tom MacArthur (R-N.J.), John Katko (R-N.Y.) and maybe Martha McSally (R-Ariz.).

That would mean that conservatives would have to put up around 20 votes to sink the repeal resolution. It’s not an impossible number, but it is challenging for the House Freedom Caucus and some like-minded conservatives, especially after conservatives groups said they would “key-vote” in favor of the resolution, and Trump tweeted some praise for the Senate.

Leadership allies sent around the tweet to undecided members on Thursday, and Republicans, who are already afraid of incurring Trump’s twitter wrath, seem to have taken note. (One conservative member suggested Ryan may have worked with incoming White House chief of staff Reince Priebus to get Trump to tweet the kind words as a warning shot.)

Either way, there are certain to be some far-right Republicans voting against the Obamacare budget resolution, which would deem the addition of more than $9 trillion in debt over the next decade as “appropriate.” In the words of fiscal hawk Rep. Walter Jones (R-N.C.), “How the hell can I vote for that?”

The question is whether Freedom Caucus leaders ultimately vote for the repeal resolution, particularly if the resolution will be agreed to on Friday. Meadows insists he’s still undecided, as does Jordan, even though the former Freedom Caucus chairman was whipping members against the resolution on Wednesday.

“Pick your metaphor,” Jordan told HuffPost Thursday night, “but I like the rural metaphor: Once you open the barn door, the horse is running, right? We’d like to know where the horse is going.”

“Once it’s running,” Jordan continued, “you can throw apples at it, and you can yell at it, but mostly we’re concerned that when the horse runs, it runs to a spot that fully repeals Obamacare.”

CHIP SOMODEVILLA VIA GETTY IMAGES


Senate opens Obamacare repeal drive with overnight marathon

Senate Republicans launched their effort to repeal and replace President Barack Obama's landmark healthcare law early Thursday morning, approving a budget blueprint that they've dubbed the Obamacare "repeal resolution."

The Senate voted 51-48 along party lines for the measure, which relies on the same budget process used seven years ago to approve the landmark healthcare law to now attempt to dismantle it.

"This resolution will set the stage for true legislative relief from Obamacare that Americans have long demanded while ensuring a stable transition," Senate Budget Chairman Mike Enzi of Wyoming said, just after 1 a.m. "The Obamacare bridge is collapsing and we're sending in a rescue team."

Kentucky Sen. Rand Paul, one of the most vocal GOP opponents of voting on a repeal bill before coming up with a replacement package, voted against the budget resolution and California Sen. Dianne Feinstein was absent.

Senators were bleary-eyed as they walked quickly to the exits, wrapping up the final vote a little before 1:30 a.m. ET.

Vermont Sen. Bernie Sanders, the top Democrat who led the late-night fight against a repeal, said the protest could be a sign of things to come as the fight stretches on.

"I think it's important for this country to know this was not a usual thing, this is a day which lays the groundwork for 30 million people to be thrown off their health insurance," Sanders said. "And if that happens, many of these people will die."

"We wanted to say no matter how late, we're going to stay and fight and represent our constituents -- there are so many constituencies who will be hurt by this repeal without a replace," said New York Sen. Chuck Schumer.

Democratic senators registered a somewhat subtle, but significant protest in the Senate as they cast their votes -- declaring why they were voting against the repeal, a rare move that rankled Republicans in the chamber.

The House is expected take a swift vote on the resolution, possibly as early as Friday, which will trigger congressional committees to begin crafting a second bill that would roll back major parts of Obamacare. Though it will be weeks before Congress votes on that bill, Thursday still marked a victory for the Republican Party as it moves toward overhauling the country's healthcare system.

President-elect Donald Trump congratulated the Senate for its actions Thursday.
"Congrats to the Senate for taking the first step to #RepealObamacare- now it's onto the House!" he tweeted.

"Vote-a-rama"
Before Thursday's vote, a political spectacle known as "vote-a-rama" unfolded on the Senate floor.

The largely symbolic exercise -- which began Wednesday evening and stretched into wee hours of Thursday -- was ripe for theater. However, the tone was largely subdued, missing some of the fire of voting marathons in previous years.

Democrats still used the late-night drill to publicly defend the Affordable Care Act and chastise their colleagues across the aisle for starting the process of overhauling a law that gives health insurance to some 20 million Americans. Republicans, meanwhile, stressed the harmful impact of the law and the urgent need to do away with it.

Senators introduced more than 160 amendments to the budget resolution, which led to a marathon session of impassioned speeches and roll call votes. Although these votes were non-binding and the budget resolution doesn't require the president's signature, the process helped crystallize the Democratic Party's top priorities as it looks to defend the major pillars of Obamacare.

The most important amendments for Democrats were aimed at preserving what they argue are popular provisions of Obamacare.

Democratic Sen. Tammy Baldwin of Wisconsin pressed a measure to allow young adults to stay on their parents insurance until age 26. "It will block Republican efforts that would weaken dependent coverage," Baldwin said in a brief but forceful floor speech before the vote.

But Republicans -- many of whom have expressed interest in maintaining the provision when they eventually replace Obamacare -- nevertheless blocked the Baldwin amendment, arguing it wasn't applicable to the underlying budget resolution.

Democrats also sought to protect measures dealing with pre-existing conditions and reproductive healthcare services for women.

Divided but some common ground
At times, the evening also showed that Republicans and Democrats share some common goals -- even if the two political parties are bitterly divided on the merits of Obamacare.

Earlier in the night, West Virginia Sen. Joe Manchin, a moderate Democrat who has called on Republicans to work in a bipartisan fashion on repealing and replacing Obamacare, emphasized the importance of preserving coverage for patients in rural areas.

No matter what happens to Obamacare, Manchin said: "We are going to make sure that we protect our rural hospitals and rural clinics."

But on the same topic, Republican Sen. John Barrasso of Wyoming argued that it was because of Obamacare that rural hospitals have shuttered.

"For people in small towns -- the closures that we've already experienced, these closures have had a devastating impact," Barrasso said.

Trump has ratcheted up the pressure this week, calling on his party to act as quickly as possible. Perhaps more significantly, Trump is adamant that Republicans vote on repealing and replacing Obamacare more or less at the same time. This is a significant divergence from the party's initial thinking that it would first vote on repeal before considering replacement options.

Trump's plan
In a news conference in Wednesday, Trump told reporters that a plan will be unveiled soon after his nominee for Health and Human Services secretary, Tom Price, is confirmed. A Georgia congressman, Price is an ardent Obamacare critic and has previously introduced detailed legislation to repeal and replace the law.

"We're going to be submitting -- as soon as our secretary's approved, almost simultaneously, shortly thereafter, a plan. It'll be repeal and replace. It will be essentially simultaneously," Trump said. "Probably the same day, could be the same hour."

Trump appeared to be suggesting that the plan would come from his administration, but a transition spokesman told CNN that he couldn't confirm whether that was Trump's intention.

Even as Republicans advanced the plan to roll back Obamacare, plans to replace were still being formulated. To that end, a small group of relatively moderate Republican senators -- including Tennessee Sen. Bob Corker and Alaska Sen. Lisa Murkowski -- initially pushed a change that would give senators until March to develop a plan to replace Obamacare. But the senators dropped that push as it became clear Wednesday that Republican leaders were moving toward replacing Obamacare as they repeal it.

Vice President-elect Mike Pence met with senators at the Capitol Wednesday. As he exited his meeting with Pence, Manchin said that the incoming VP promised a draft replacement for Obamacare would be available in 30-60 days.
Republicans on the Hill do not yet have a plan for replacing Obamacare, and are considering a series of possible legislative paths to replace what they vote to repeal.

It's also not clear that one comprehensive "replacement" bill will ultimately emerge from GOP lawmakers -- in fact, senior leaders are currently weighing the option of incremental replacement bills.

For example, they are exploring whether replacement measures could be inserted into the "repeal" reconciliation bill, which Republicans hope to vote on by late February or March. Leaders are also looking into whether any replacement or healthcare reform measures could be inserted into reauthorization bills that Congress is expected to take up later this year.


Senate opens Obamacare repeal drive with overnight marathon

Senate Republicans launched their effort to repeal and replace President Barack Obama's landmark healthcare law early Thursday morning, approving a budget blueprint that they've dubbed the Obamacare "repeal resolution."

The Senate voted 51-48 along party lines for the measure, which relies on the same budget process used seven years ago to approve the landmark healthcare law to now attempt to dismantle it.

"This resolution will set the stage for true legislative relief from Obamacare that Americans have long demanded while ensuring a stable transition," Senate Budget Chairman Mike Enzi of Wyoming said, just after 1 a.m. "The Obamacare bridge is collapsing and we're sending in a rescue team."

Kentucky Sen. Rand Paul, one of the most vocal GOP opponents of voting on a repeal bill before coming up with a replacement package, voted against the budget resolution and California Sen. Dianne Feinstein was absent.

Senators were bleary-eyed as they walked quickly to the exits, wrapping up the final vote a little before 1:30 a.m. ET.

Vermont Sen. Bernie Sanders, the top Democrat who led the late-night fight against a repeal, said the protest could be a sign of things to come as the fight stretches on.

"I think it's important for this country to know this was not a usual thing, this is a day which lays the groundwork for 30 million people to be thrown off their health insurance," Sanders said. "And if that happens, many of these people will die."

"We wanted to say no matter how late, we're going to stay and fight and represent our constituents -- there are so many constituencies who will be hurt by this repeal without a replace," said New York Sen. Chuck Schumer.

Democratic senators registered a somewhat subtle, but significant protest in the Senate as they cast their votes -- declaring why they were voting against the repeal, a rare move that rankled Republicans in the chamber.

The House is expected take a swift vote on the resolution, possibly as early as Friday, which will trigger congressional committees to begin crafting a second bill that would roll back major parts of Obamacare. Though it will be weeks before Congress votes on that bill, Thursday still marked a victory for the Republican Party as it moves toward overhauling the country's healthcare system.

President-elect Donald Trump congratulated the Senate for its actions Thursday.
"Congrats to the Senate for taking the first step to #RepealObamacare- now it's onto the House!" he tweeted.

"Vote-a-rama"
Before Thursday's vote, a political spectacle known as "vote-a-rama" unfolded on the Senate floor.

The largely symbolic exercise -- which began Wednesday evening and stretched into wee hours of Thursday -- was ripe for theater. However, the tone was largely subdued, missing some of the fire of voting marathons in previous years.

Democrats still used the late-night drill to publicly defend the Affordable Care Act and chastise their colleagues across the aisle for starting the process of overhauling a law that gives health insurance to some 20 million Americans. Republicans, meanwhile, stressed the harmful impact of the law and the urgent need to do away with it.

Senators introduced more than 160 amendments to the budget resolution, which led to a marathon session of impassioned speeches and roll call votes. Although these votes were non-binding and the budget resolution doesn't require the president's signature, the process helped crystallize the Democratic Party's top priorities as it looks to defend the major pillars of Obamacare.

The most important amendments for Democrats were aimed at preserving what they argue are popular provisions of Obamacare.

Democratic Sen. Tammy Baldwin of Wisconsin pressed a measure to allow young adults to stay on their parents insurance until age 26. "It will block Republican efforts that would weaken dependent coverage," Baldwin said in a brief but forceful floor speech before the vote.

But Republicans -- many of whom have expressed interest in maintaining the provision when they eventually replace Obamacare -- nevertheless blocked the Baldwin amendment, arguing it wasn't applicable to the underlying budget resolution.

Democrats also sought to protect measures dealing with pre-existing conditions and reproductive healthcare services for women.

Divided but some common ground
At times, the evening also showed that Republicans and Democrats share some common goals -- even if the two political parties are bitterly divided on the merits of Obamacare.

Earlier in the night, West Virginia Sen. Joe Manchin, a moderate Democrat who has called on Republicans to work in a bipartisan fashion on repealing and replacing Obamacare, emphasized the importance of preserving coverage for patients in rural areas.

No matter what happens to Obamacare, Manchin said: "We are going to make sure that we protect our rural hospitals and rural clinics."

But on the same topic, Republican Sen. John Barrasso of Wyoming argued that it was because of Obamacare that rural hospitals have shuttered.

"For people in small towns -- the closures that we've already experienced, these closures have had a devastating impact," Barrasso said.

Trump has ratcheted up the pressure this week, calling on his party to act as quickly as possible. Perhaps more significantly, Trump is adamant that Republicans vote on repealing and replacing Obamacare more or less at the same time. This is a significant divergence from the party's initial thinking that it would first vote on repeal before considering replacement options.

Trump's plan
In a news conference in Wednesday, Trump told reporters that a plan will be unveiled soon after his nominee for Health and Human Services secretary, Tom Price, is confirmed. A Georgia congressman, Price is an ardent Obamacare critic and has previously introduced detailed legislation to repeal and replace the law.

"We're going to be submitting -- as soon as our secretary's approved, almost simultaneously, shortly thereafter, a plan. It'll be repeal and replace. It will be essentially simultaneously," Trump said. "Probably the same day, could be the same hour."

Trump appeared to be suggesting that the plan would come from his administration, but a transition spokesman told CNN that he couldn't confirm whether that was Trump's intention.

Even as Republicans advanced the plan to roll back Obamacare, plans to replace were still being formulated. To that end, a small group of relatively moderate Republican senators -- including Tennessee Sen. Bob Corker and Alaska Sen. Lisa Murkowski -- initially pushed a change that would give senators until March to develop a plan to replace Obamacare. But the senators dropped that push as it became clear Wednesday that Republican leaders were moving toward replacing Obamacare as they repeal it.

Vice President-elect Mike Pence met with senators at the Capitol Wednesday. As he exited his meeting with Pence, Manchin said that the incoming VP promised a draft replacement for Obamacare would be available in 30-60 days.
Republicans on the Hill do not yet have a plan for replacing Obamacare, and are considering a series of possible legislative paths to replace what they vote to repeal.

It's also not clear that one comprehensive "replacement" bill will ultimately emerge from GOP lawmakers -- in fact, senior leaders are currently weighing the option of incremental replacement bills.

For example, they are exploring whether replacement measures could be inserted into the "repeal" reconciliation bill, which Republicans hope to vote on by late February or March. Leaders are also looking into whether any replacement or healthcare reform measures could be inserted into reauthorization bills that Congress is expected to take up later this year.


Congress Is Headed for a Showdown With Trump Over Obamacare Repeal

Suddenly President-elect Donald Trump and some Republican congressional leaders are pulling in different directions in their drive to dismantle Obamacare.

While “repeal and replace” was a highly effective campaign slogan that helped the Republicans win the White House and retain control of the House and Senate, it has now become an albatross around the necks of the incoming president and Senate and House GOP leaders.

No one really knows what repeal and replace actually means. Senate Majority Leader Mitch McConnell (R-KY), a major cheerleader for dismantling President Obama’s signature health insurance program, insists the way to go is to repeal the program with a lengthy transition period and then come back with a full blown replacement down the road.

But that’s not what Trump has in mind. Trump vowed during a press conference at Trump Tower on Wednesday to unveil proposals to repeal and then replace the Affordable Care Act literally within days or hours of each other by next month, after Rep. Tom Price (R-GA), his choice to head HHS, is confirmed by the Senate.

In the wee hours of Thursday morning, the Senate voted 51 to 48 to formally kick off the process of repealing Obamacare, with two Senate committees required to report back by Jan. 27 with specific language for gutting key provisions of the law, including taxes, premium subsidies and mandates on individuals and businesses. McConnell told reporters on Tuesday that his office will be working with Trump’s new Department of Health and Human Services officials to “craft the way forward” in replacing Obamacare – but that the “first step towards replacement is to repeal.”

“It will be essentially simultaneously,” Trump told reporters in New York. “It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day, could be the same hour … And we’re going to get a health bill passed. We’re going to get health care taken care of in this country.”

Meanwhile, House Speaker Paul Ryan (R-WI) has gradually been inching towards Trump’s position, telling reporters earlier this week that Congress would do repeal and replace “concurrently,” rather than “simultaneously,” which would leave the lawmakers with a little more latitude in designing a comprehensive replacement. Ryan also said he was exploring options for including parts of a replacement plan in the budget reconciliation bill approved by the Senate and that awaits House action on Friday.

In a news conference on Capitol Hill today, the Speaker declared, “I’ve spoken with President-elect Trump probably two times in the last three days on this and [Vice President-elect] Mike Pence was in my office yesterday to discuss this, and we agree we want to make sure that we move these things concurrently, at the same time, repeal and replace.”

Timing is everything in politics, as the saying goes, and Congress and the incoming Trump administration may be on a collision course. If McConnell persuades lawmakers in both chambers to move full steam ahead on repealing Obamacare – with the understanding that a comprehensive GOP replacement would be dealt with later – Trump may be confronted with a repeal-now, replace-later bill on his desk in the Oval Office contrary to what he says he wants.

The notion of Trump vetoing a bill dealing with Obamacare seems unthinkable at this point, although the president-elect has shown no reluctance to call out or challenge congressional Republicans when he disagrees with them. However, with Trump bearing down on Ryan and McConnell to make good quickly on his campaign pledge to repeal and replace the “disastrous” Obamacare program, the president-elect is more likely than not to get his way.

The idea once advanced by some veteran GOP lawmakers including Sen. Lamar Alexander of Tennessee, the chair of the Health, Education, Labor and Pensions Committee, and Finance Committee Chair Orrin Hatch of Utah that it might take another year or two to fashion a replacement plan now seems out of the question.

Yet, Trump, Ryan and McConnell are kidding themselves if they think any permutation of repeal and replace legislation they dream up will have smooth sailing through Congress. That’s especially true amid the growing unease among GOP lawmakers in both chambers about their party overplaying their hand, and in the process triggering a collapse of the health insurance market and stripping millions of Americans of their coverage in the coming year or two.

“Congressional Republicans are like the dog that finally caught the car,” said William Galston, a political scholar at the Brookings Institution and one-time domestic policy adviser to President Bill Clinton. “And the questions that they have tap-danced around for six years are now squarely on the front burner.”

“Across party lines, health care experts are sending up rockets of alarm about this destabilization of the entire health care markets that could occur if there is a significant interval between the repeal and the replace,” he added today. “I think that President-elect Trump has much better political instincts than Mitch McConnell does. I think it’s increasingly clear that the momentum has shifted in favor of a much smaller gap between repeal and replace.”

Joseph Antos, a health care expert with the conservative-leaning American Enterprise Institute, said yesterday that Trump’s timetable for simultaneous action “seems impossible to me,” and that developing a complex replacement plan could take many months if the new president is serious about changing the law. Because Republicans are using special budget reconciliation rules to repeal Obamacare, McConnell needs to muster a simple majority of 51 votes to ram through repeal legislation.

McConnell was able just to muster 51 votes on Thursday to pass the preliminary budget action after Sen. Rand Paul (R-KY) sided with the Democrats in trying to stop the measure.

However, those rules won’t apply when Congress must do the much more challenging task of drafting sweeping replacement legislation, which must be approved in the Senate by a 60-vote supermajority. When the time comes for that, McConnell will have to seek out a handful of moderate Democrats to push the replacement legislation through. That won’t be easy because Senate Democratic Leader Chuck Schumer of New York is unwilling to bail out the Republicans unless they agree to delay repeal while the two sides hash out a bipartisan compromise.

“It is more than possible for Trump and the Republicans to have a decent outline of the major themes of a replacement, but the idea of having a bill that is ready to go is out of the question,” Antos said in an interview. “That’s not just because of the complexity but because of the need for negotiations with Republicans first and then ultimately there will have to be negotiations with Democrats.”

“And all of those negotiations end up changing something or other,” he added.

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