Donald Trump and Congressional Republicans may be getting off to a rocky start on how to deal with repealing and replacing the Affordable Care Act. The President-elect has made it clear that he expects the landmark healthcare law to be both repealed and replaced by Congress in short order. His insistence on a hasty replacement for the Affordable Care Act has some Republican lawmakers on Capitol Hill worried. Though many of them disagree with Obamacare, they recognize that replacing such a complex piece of legislation will be no easy task. Demands to fast-track the repeal and replacement process would leave little time for crafting legislation, fine tuning the details and carefully implementing new provisions.
Trump, however, seems undaunted by this monumental challenge. He does not seem to be at all open to the idea of allowing a repeal vote to go forward without the immediate implementation of a concrete replacement healthcare plan. Though used to working in the fast-paced business world, the President-elect may soon discover that decisions are often made much more slowly in D.C., with plenty of time afforded for changes to legislation after committees have worked out compromises and there’s been ample opportunity for discussion. Disagreement over the timing of replacement is just one of a long list of issues where the President-elect seems to be at odds with key members of his own party.
Finding the Right Time
One obstacle to instant repeal and replacement of the Affordable Care Act could be the already busy schedule of issues crowding the Congressional docket. Between hearings on governmental appointees and other regular business, demanding a vote on the complete overhaul of healthcare reform by “probably sometime next week”, as Trump has demanded, could prove to be a challenging proposition indeed.
Repeal of Obamacare has long been an aspiration of many Republican party legislators. By the end of next week, once Trump has been sworn into office, they’re planning to seek for both Houses of Congress to pass provisions that would prevent filibustering from interfering with plans to repeal the ACA.
Though House Speaker Ryan is on board with Trump’s projected timetable for repealing the Affordable Care Act, his colleagues in Congress have widely divergent views about replacement plans. If the Democratic minority puts up resistance to the changes, which is almost certain to happen, the repeal-and-replace strategy could be even more of an uphill climb.
Then there’s the sticky business of trying to decide if, and how, certain popular aspects of the healthcare law could be kept without the entire system falling apart. Well-liked provisions include the mandate that insurance companies accept clients with pre-existing conditions and that dependents be allowed to stay on their parents’ insurance policies up to age 26. Many Republicans realize that if they pass legislation eliminating these provisions, they run the risk of having widespread public opinion turn against them overnight.
Taking Political Responsibility
Now that Republicans dominate both houses of legislature, they’ll be responsible for the success or failure of whatever legislation follows the Affordable Care Act’s repeal. If they repeal the current law without a plan in place, there could be dire unintended consequences that would haunt their careers and potentially wreak havoc on the United States healthcare system. If Republican actions lead to the marketplace becoming unstable, fewer people being insured or coverage being watered down, it could spell a political nightmare for them in the next election cycle. Unwilling to run the risk of permanently damaged legacies, five Republicans in the Senate and a number of Republicans in the House have urged their fellow lawmakers to delay committee deadlines for hearings on replacement legislation for a couple of months after Trump’s inauguration.
Under the current budget resolution, Senate and House committees have only until January 27 to come up with legislation that would repeal the Affordable Care Act. After passing such legislation, there would still be plenty of loose ends for Congress to deal with, such as coming up with a new health insurance coverage system and deciding on a timescale under which it would be implemented.
Noticing talk among some Republican members of Congress about delaying Obamacare replacement, the President-elect has become increasingly vocal in recent days about his disapproval over legislators’ hesitancy to act. Using inflammatory terminology, Trump has described the Affordable Care Act as “a catastrophic event.” He even threatened Democratic lawmakers who may try to oppose his plans to repeal and replace the ACA, stating that he would highlight their failure to comply in efforts to see them defeated in their 2018 re-election bids. Since the Republicans are eight votes shy of a filibuster-proof majority, they need Democratic bipartisan support for smaller pieces of legislation that will affect future replacement plans.
Democratic legislators, by and large, hold a completely different opinion on Obamacare. They point to the record high number of Americans who currently have health insurance as well as increasing enrollment numbers this year as proof of the much-maligned healthcare law’s success. Both HealthCare.gov and state marketplace platforms continue to see new enrollment as well as re-enrollment each year. As of Tuesday, January 3, current enrollment numbers (including automatic re-enrollment) stood at 11.5 million people nationwide, and numbers continue to grow as open enrollment for Obamacare runs through January 31.
Time will tell which approach will work – the immediate repeal-and-replace promise of Trump and certain Congressional Republicans, or the repeal-and-delay strategy developed by other Republicans who are more reluctant to follow such a hasty course of action. One thing that’s clear is that the President-elect, as on so many other issues, will likely to continue to publicly call out any who oppose his philosophy or strategies. Whether this bold, brazen and outspoken leadership style ends up leading to widespread cooperation or resistance remains to be seen in the months and years that lie ahead.