GOP finds re­peal­ing Oba­macare will be eas­ier said than done


— Key Repub­li­cans in Congress are cau­tion­ing that re­plac­ing Oba­macare will be a dif­fi­cult and lengthy process that won’t hap­pen in the first days of Pres­i­dent-elect Don­ald Trump’s ad­min­is­tra­tion.

Re­peal is the sim­ple part, said Se­nate Fi­nance Com­mit­tee Chair­man Or­rin Hatch, a Utah Repub­li­can and key player in the health de­bate. Find­ing a re­place­ment is harder.

“It’s not go­ing to be an easy process, but I think Democrats and Repub­li­cans will work to­gether to get a bet­ter sys­tem,” Hatch said to re­porters in Wash­ing­ton on Wed­nes­day.

The 2010 Af­ford­able Care Act, as Oba­macare is also known, took years to leg­is­late and im­ple­ment. Trump and Repub­li­cans have said they want to keep some parts of the law, like pop­u­lar pro­vi­sions guar­an­tee­ing cov­er­age. They have yet to set­tle on other mat­ters, though, like whether or how much fi­nan­cial sup­port to give peo­ple. A re­peal signed in Trump’s first days might not take ef­fect right away — giv­ing Repub­li­cans a lengthy pe­riod to try and write com­plex pol­icy and avoid a sud­den shock to the health-care sys­tem.

“It’s go­ing to be harder than a lot of us think,” said Sen. Lind­sey Gra­ham, a South Carolina Repub­li­can who op­posed Trump’s run for pres­i­dent and has called for Oba­macare’s re­peal and re­place­ment.

What­ever Repub­li­cans de­cide on may take years to im­ple­ment. When a Repub­li­can-writ­ten re­peal bill was sent to Pres­i­dent Barack Obama in Jan­uary, and ve­toed, it in­cluded a two-year de­lay be­fore kick­ing in. House Ways and Means Com­mit­tee Chair­man Kevin Brady, a Repub­li­can from Texas, said dis­cus­sions are on­go­ing on re­peal and re­place, in­clud­ing on the idea of a builtin de­lay and what else would be in a bill.

“The an­swer is to be de­ter­mined,” Brady told re­porters this week.

Health in­sur­ers are wait­ing to see what Repub­li­cans pro­pose, and urg­ing Trump and the Repub­li­can Congress not to dis­rupt the health-care sys­tem fur­ther.

“At the mo­ment, our mes­sage is, ‘Let’s be thought­ful,’” said Ceci Con­nolly,


Bloomberg News chief ex­ec­u­tive of­fi­cer of the Al­liance of Com­mu­nity Health Plans, which lob­bies on be­half of re­gional and state-based in­sur­ers. “Let’s not dis­rupt mil­lions of peo­ple.”

Repub­li­cans could keep those pro­vi­sions they fa­vor, like guar­an­tee­ing cov­er­age for pre-ex­ist­ing con­di­tions, and elim­i­nate one they strongly op­pose, the “in­di­vid­ual man­date” — a re­quire­ment that all Americans pur­chase health cov­er­age or face a fi­nan­cial penalty.

Yet with­out a man­date, they would need to find a way to con­vince a broad group of Americans to buy cov­er­age, help­ing spread the risk for in­sur­ers. Con­ser­va­tives in Congress and around Wash­ing­ton have put forth sev­eral al­ter­na­tives.

Speaker of the House Paul Ryan has pre­vi­ously pro­posed tax in­cen­tives to help peo­ple buy cov­er­age, sim­i­lar to Oba­macare, as well as pro­tec­tion from ris­ing rates linked to ill­ness for those who main­tain con­tin­u­ous in­sur­ance cov­er­age.

Un­der Oba­macare, while the U.S. has reached a near record low num­ber of unin­sured, the law has had trou­bles. Large in­sur­ance com­pa­nies, in­clud­ing Unit­edHealth Group Inc. and Aetna Inc., have pulled back from sell­ing cov­er­age. Pre­mi­ums are ris­ing rapidly. And be­cause many plans fea­ture high de­ductibles, a Com­mon­wealth Fund study this year found that about four in 10 adults in ACA plans aren’t con­fi­dent they could af­ford care if they got sick.

Still, more than 1 mil­lion peo­ple se­lected in­sur­ance plans through Oba­macare in the first two week of sign-ups this month, the U.S. said in a re­port Wed­nes­day. More than 246,000 of those were new con­sumers.

“I think Trump has the idea that things move very quickly in his world, but his world is very dif­fer­ent than the po­lit­i­cal world,” said Behrends Foster, a part­ner at Blue­stone Strate­gies who pre­vi­ously worked for the health in­sur­ance lobby.

Democrats are likely to op­pose the re­peal bill, forc­ing Repub­li­cans to use a pro­ce­dural move to speed the process. Then, both par­ties will have dig in and leg­is­late poli­cies that could re­place the parts of Oba­macare that were elim­i­nated. That won’t hap­pen on Trump’s first day, said Joseph An­tos, a scholar at the Amer­i­can En­ter­prise In­sti­tute, a con­ser­va­tive think tank in Wash­ing­ton that’s been a repos­i­tory of Repub­li­can-fa­vored health poli­cies.

“What we’re go­ing to see is a very long, typ­i­cal Wash­ing­ton process,” An­tos said.

With as­sis­tance from Steven T. Den­nis, Laura Lit­van and Erik Was­son.


The web­site is shown on Oct. 25. Signups for health care have ac­cel­er­ated af­ter Don­ald Trump was elected pres­i­dent.

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