(Bloomberg) – House Republican leaders said Tuesday they would push ahead with their swift repeal of the ACA, even as a breakaway group of five moderate Senate Republicans is trying to delay a bill until March.
If those senators stand firm on their demand to flesh out a replacement before acting on a repeal, it could be enough pressure to force the party’s leadership to comply. But House Speaker Paul Ryan said the election result affirmed the need for urgency.
“This is a rescue mission,” Ryan said.
Even so, Republicans in both chambers are showing growing uneasiness about the rush to deliver swiftly on one of President-elect Donald Trump’s top campaign promises.
Senators Bob Corker of Tennessee, Rob Portman of Ohio, Susan Collins of Maine, Bill Cassidy of Louisiana and Lisa Murkowski of Alaska offered an amendment Monday night to the budget resolution that would extend the target date for the committees to write an ACA repeal bill to March 3 from Jan. 27.
“As President-elect Trump has stated, repeal and replace should take place simultaneously, and this amendment will give the incoming administration more time to outline its priorities," Corker said in a statement. "By extending the deadline for budget reconciliation instructions until March, Congress and the incoming administration will each have additional time to get the policy right."
With Democrats opposed to a straight repeal bill, Republicans can lose no more than one backer if they want to fast-track their approach before Trump takes office. Republican leaders in the Senate are hoping to adopt the budget resolution -- which would allow an ACA repeal bill to pass with 50 votes and escape a Senate filibuster -- early Thursday after a marathon session of amendment votes.
More broadly, the amendment reflects the deep divisions, which persist nearly seven years into Republicans’ promises to repeal and replace the ACA, within the party on what kind of system to set up. Views range from a minimalist approach -- favored by the most conservative members -- that lets the market work its will, to a substantial, but scaled-back government role that maintains significant parts of the law, such as financial assistance to cover low-income people under Medicaid.
On the House side, the new chairman of the conservative Freedom Caucus said his group wants to see more details about an ACA replacement before voting on the budget resolution.
"We hope they would see the prudence of waiting," Representative Mark Meadows of North Carolina said Monday night.
Interviews with many Republicans indicate that the party is no closer to consensus two months after an election that gave them unified control of the White House and Congress.
Even before the new amendment was offered, Cassidy, Collins and other senators pushed to delay any repeal of ACA tax hikes so that there would be revenue to pay for a replacement plan. This puts them at odds with House conservatives, who have been demanding a full, immediate repeal.
On Monday, more senators said they agreed with a delay on the tax front, including Senator Mike Rounds of South Dakota.
John Cornyn, the No. 2 Senate Republican, told reporters that the taxes used to subsidize insurance for millions of Americans could be dealt with later this year in a larger tax overhaul.
Republicans senators are also grappling with the risks of repealing the law before a replacement is ready.
Senator Ron Johnson of Wisconsin said he wants to see a "pretty darn specific” proposal to replace the ACA before it’s repealed.
"Let’s start taking test votes on the different elements” and "start making the political points” for "what is going to be a more rational health-care system that actually works,” Johnson said in an interview. "There is enough resistance and probably recognition” among Republicans that the Senate is likely to move slowly on repeal, he said. "It sounds like President-elect Trump is kind of weighing into it as well, saying, be a little careful here — we repeal it, it’s ours."
Other Republicans are still supporting their leaders’ strategy. Senator Tim Scott of South Carolina said that "if there is a vote to repeal Obamacare I’m going to vote yes," but he wants a three-year delay in implementation for a "comfortable landing." Others also support a swift repeal vote.
"You have to replace it once you repeal. There’s a good case to be made to have a trigger that triggers the replacement so everyone knows it’s coming. But having them both together is not a necessity," said Senator Johnny Isakson of Georgia.
Outside groups are also putting pressure on the House GOP to act quickly.
"Political risk, real or imagined, should not be used as an excuse for members of Congress to avoid doing the job they signed up for in November," James Wallner, a vice president at the conservative Heritage Foundation, wrote in an op-ed. “No one said it was going to be easy."
Senator Lamar Alexander of Tennessee, the chair of the health committee, indicated that the process of voting to replace the ACA would take until the summer to complete, and said Republicans are "going to do this step by step."
"We need to carefully reform and replace Obamacare, and when it takes effect, we can finally repeal Obamacare. And so we’ve got to get the right sequencing on this," Alexander told reporters. "In my view we need to cast most of our votes on that before summer time. It’ll probably take two or three steps and then it’ll probably take two or three years to implement it over time."
Another source of GOP division is whether a replacement should insure as many people as the ACA does, in order to avoid the political fallout of throwing people off coverage. Some Republicans, such as Senator Shelley Moore Capito of West Virginia, say they want their party’s alternative to cover at least as many Americans. Others demur on the question: "We’ll see. We don’t know yet," said Alexander.
The backers of the new amendment insist that they remain committed to the goal of dismantling President Barack Obama’s health-care law.
"This amendment will ensure that we move forward with a smart, responsible plan to replace the law as quickly as possible," Portman said.
Murkowski said it’s simply "common sense" that repeal and replace happen simultaneously.
“I remain committed to repealing the Affordable Care Act, and I am equally committed to ensuring that all Alaskans and Americans, especially the most vulnerable among us and those in rural communities, have access to affordable, quality health care," Murkowski said.
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