Af­ter health-care re­peal vote, some in GOP fear a cliff ‘Wouldn’t take ef­fect for per­haps three years’

Kuwait Times - - HEALTH & SCIENCE -

Repub­li­cans are ea­gerly plan­ning ini­tial votes next month on dis­man­tling Pres­i­dent Barack Obama’s health care law, a cher­ished GOP goal. But many worry that while Congress tries to re­place it, the party will face ever-an­grier vot­ers, spooked health in­sur­ers and the pos­si­bil­ity of tum­bling off a po­lit­i­cal cliff.

Repub­li­cans have said they first want to vote to un­wind as much of the health care law as they can, though it wouldn’t take ef­fect for per­haps three years. That’s to give them and new Pres­i­dent Don­ald Trump time to write leg­is­la­tion con­struct­ing a new health care sys­tem - a tech­ni­cally and po­lit­i­cally daunt­ing task that has frus­trated GOP at­tempts for unity for years.

Many con­gres­sional Repub­li­cans worry they’d be vul­ner­a­ble dur­ing the tran­si­tion pe­riod be­tween a re­peal vote and ac­tu­ally re­plac­ing Obama’s law with a new sys­tem. Twenty mil­lion peo­ple now cov­ered would face uncer­tainty about their fu­ture ben­e­fits, while unset­tled health in­sur­ers might quickly start boost­ing pre­mi­ums or stop sell­ing poli­cies in some ar­eas to pro­tect them­selves.

In both cases, pub­lic wrath could be aimed at the party con­trol­ling the White House and Capi­tol - the GOP. “It’s go­ing to be a dif­fi­cult chal­lenge to pass a re­place­ment” for Obama’s law and make sure some peo­ple don’t lose cov­er­age, Sen. Su­san Collins, R -Maine, said. Health in­sur­ers will need time to ad­just to a new sys­tem and if Congress waits un­til the last minute to en­act a new law, “It’s not go­ing to work,” she said.

An­other fear

A re­lated fear: Congress and Trump en­act leg­is­la­tion dis­man­tling Obama’s law but as the clock ticks down to its ex­pi­ra­tion, the GOP re­mains di­vided over re­plac­ing it. The po­lit­i­cal im­per­a­tive for Repub­li­cans to pass some­thing would be over­whelm­ing but with Congress be­ing Congress, there are no guar­an­tees. “When you set up a cliff, you can go over it,” Rep. Char­lie Dent, R-Pa., said. Many Repub­li­cans in­sist that won’t hap­pen. They view set­ting an end date on Obama’s law as a way to force con­gres­sional ac­tion on re­plac­ing it with­out hurt­ing con­sumers. “There needs to be a rea­son­able tran­si­tion pe­riod so peo­ple don’t have the rug pulled out from un­der them,” House Speaker Paul Ryan, R-Wis., told re­porters last week.

But in one of many ques­tions di­vid­ing Repub­li­cans, they dif­fer over what a rea­son­able tran­si­tion pe­riod means. No. 2 Se­nate Repub­li­can, John Cornyn of Texas, said there will likely be a three-year gap be­tween Congress’ votes to re­peal Obama’s law and when that would ac­tu­ally kick in. “We’re not go­ing to let any­body fall through the cracks,” Cornyn said.

Other Repub­li­cans, par­tic­u­larly in the House, worry that three years is too long to leave vot­ers, in­sur­ers and health care providers in sus­pense. Ea­ger to pre­vent a drawn-out ef­fort to pass new health care leg­is­la­tion from spin­ning into a dam­ag­ing is­sue for the 2018 cam­paigns, many want the process to take a year or less. “I hope it’s not years with no re­place­ment,” said Rep. Steve Stivers, R Ohio, who next year will head the Na­tional Repub­li­can Con­gres­sional Com­mit­tee, the House GOP’s po­lit­i­cal or­ga­ni­za­tion. “Qual­ity matters more than speed, but speed can’t be ig­nored. You don’t want the Amer­i­can peo­ple to feel too un­com­fort­able for too long.”

Bring it on

Rep. Jeff Den­ham, R-Calif., re-elected nar­rowly last month, said he wants Repub­li­cans to “pro­vide cer­tainty” within a year. He said that means show­ing in Jan­uary “not only what our vi­sion is, but putting it in print, start pass­ing it through com­mit­tees and get some con­sen­sus with the Se­nate. But it is some­thing that we need to re­solve within the year.”

Repub­li­cans have yet to de­cide what their re­place­ment will look like. Though de­tails are scant, Trump and Ryan have pro­posed tax breaks to help peo­ple pay in­sur­ance pre­mi­ums. Both want to elim­i­nate Obama’s man­date that most in­di­vid­u­als get cov­er­age and most em­ploy­ers cover work­ers, but that could be re­placed with a re­quire­ment that peo­ple main­tain “con­tin­u­ous” cov­er­age or face higher pre­mi­ums.

Democrats, who en­acted Obama’s law in 2010 over solid GOP op­po­si­tion, have sig­naled they won’t help Repub­li­cans de­mol­ish it. “Bring it on,” Sen. Chuck Schumer, D-N.Y., next year’s mi­nor­ity leader, said of GOP re­peal ef­forts. “They have noth­ing to put in its place.”

Ryan and Se­nate Ma­jor­ity Leader Mitch McCon­nell, R-Ky., said last week that the GOP­con­trolled Congress plans to pass a pro­ce­dural mea­sure in Jan­uary that will let Repub­li­cans push re­peal leg­is­la­tion through the Se­nate later with just a sim­ple ma­jor­ity. That’s im­por­tant be­cause with the Se­nate GOP hold­ing a 52-48 ma­jor­ity next year, Democrats would oth­er­wise be able to block a re­peal bill un­less it gets 60 votes.

The early pro­ce­dural vote could also sig­nal that the GOP is in­tent on re­peal­ing Obama’s law, while sav­ing the more dif­fi­cult de­tails for later. They are still de­cid­ing what that part of the process will look like - and what their re­place­ment will be. —AP

WASH­ING­TON: In this Dec 1, 2016, file photo, House Speaker Paul Ryan of Wis., speaks dur­ing a news con­fer­ence on Capi­tol Hill. —AP

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