Congress approves what could be beginning of end for Obamacare; Reps. Labrador and Simpson disagree on direction

January 14, 2017 GMT

WASHINGTON — The Republican-led Congress has passed a plan to start the process of repealing the Affordable Care Act, but the road ahead remains unclear.

House Republicans approved the budget blueprint by a 227-198 vote on Friday following a similar party-line vote by the Senate earlier in the week. The votes set a month-end timetable to draft a repeal bill, but congressional leaders warned the process could take longer.

Both Idaho Sens. Mike Crapo of Idaho Falls and Jim Risch of Boise voted for the budget measures to repeal Obamacare during the Senate vote. Idaho’s House members were split on the matter during Friday’s vote with Rep. Mike Simpson of Idaho Falls voting in favor of the repeal legislation and Rep. Raul Labrador of Eagle voting against.

Labrador said he opposed the resolution on fiscal grounds.

“America’s debt presents the gravest threat to our future. While I’m fully committed to repealing Obamacare, we shouldn’t do so with a budget that refuses to address the threat and puts us another $10 trillion in the red,” Labrador said.

Simpson said Obamacare has clearly not lived up to expectations and needs to be replaced with something that works.

“It is no secret that Obamacare has not lived up to the promises made six years ago,” Simpson said Friday. “Obamacare has led to higher premiums, higher deductibles and fewer choices – and this is before the most egregious tax hikes have gone into effect. I hear from Idahoans daily about the struggles associated with this law, and today’s legislation represents an important step in replacing Obamacare with real health care reform that puts decisions back into the hands of families, patients and doctors.”

The past week was full of theatrics as Republicans struggled to fulfill one of their major campaign promises.

One by one, Republicans rose at their desks to criticize Obamacare — Rep. Drew Ferguson, R-Ga., compared the ACA to a goat ransacking the interior of a house. “I have to get the goat out,” he said.

And after each GOP speech, Democrats reminded lawmakers of how many hundreds of thousands of Americans might lose their health care coverage in that lawmaker’s state if Obamacare is repealed — more than 580,000, for example, in Georgia.

But the beginning the repeal process was the easy part. Republicans aren’t any closer to fulfilling their longtime promise to “repeal and replace Obamacare,” even though they will now control the House, Senate and White House.

President-elect Donald Trump said last week that he expects Congress to act swiftly, promising that a plan will be coming as soon as his pick for Health and Human Services secretary, Rep. Tom Price, R-Ga., is confirmed for the Cabinet.

“It’ll be repeal and replace. It will be essentially, simultaneously,” Trump said. “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.”

Republican leaders, though, know that is a promise easier made than kept.

Ever since President Barack Obama signed the health care bill into law in 2010, Republicans have been unable to coalesce around a viable option.

“We’re not holding hard deadlines, only because we want to get it right,” said House Speaker Paul D. Ryan, R-Wis. He has committed to having repeal and replace done “this year.”

But without a clear path forward, rank-and-file GOP lawmakers are becoming increasingly nervous that constituents back home will lose their health care coverage if the ACA is repealed before a replacement is enacted.

In closed-door meetings over the past two weeks, Republicans have expressed much “hand-wringing,” as one lawmaker put it. One congressman quoted Scripture in asking colleagues to ensure they had a sturdy foundation before pressing ahead with the repeal.

“We do have members who feel if we don’t do them together, the replacement plan will never happen,” acknowledged Rep. Chris Collins, R-N.Y., an early Trump supporter. “People will, I hope, fall in line with our new president, make sure we are supportive of him coming right out of the gate.”

As voting was underway last week, Republican aides were increasingly suggesting another course of action.

They say the Obamacare replacement will not be a single bill, but a series of actions — some made through regulatory changes by Price at the Department of Health and Human Services, others by Trump’s executive actions, and some in legislation — to build a new health care system.

That process could drag throughout 2017, with many of the changes not expected to be phased in for several years to ease the transition.

“We’re not going to swap one 2,700-page monstrosity for another,” Ryan said, referring to the Obamacare law.

Republicans have promised their plan will lower the consumer costs of health insurance premiums and deductibles, and give people more choices in choosing coverage. They have floated ideas for expanding tax-exempt health savings accounts and giving lower-income Americans refundable tax credits toward buying their own coverage. They want to end the mandate that all Americans have insurance.

But without legislation, those ideas remain only works in progress.

Meanwhile, approximately 20 million people are now benefiting from Obamacare, either by purchasing private insurance on the ACA exchanges or receiving health coverage through the Medicaid expansion. Many people receive government subsidies to defray the costs.

Repealing Obamacare threatens to wipe out that system without providing a new one.

“Why don’t they have a remedy?” said Rep. Maxine Waters, D-Calif. “They’re not going to have anything better than the ACA.”

Approval of the budget package Friday sends instructions to various congressional committees to draft legislation to repeal Obamacare by Jan. 27. But aides cautioned that deadline is not binding, and may slip.

Republicans have approved countless bills to repeal Obamacare before, but their off-the-shelf model needs some fine-tuning now that it has a chance under Trump to become law, they said.

Both Ryan and Senate Majority Leader Mitch McConnell, R-Ky., hope some of the replacement elements can be tucked into the repeal bill, providing a safety net as they dismantle Obamacare.

But because the repeal bill is part of the budget process, it must hew to budgetary provisions, which throws into question some of the most popular parts of Obamacare — such as allowing young people to remain on parents plans until they are 26 years old or prohibiting insurance companies from denying coverage for those with pre-existing conditions.

The Idaho State Journal contributed to this report.