Ariz. GOP finds ACA repeal a bitter pill
Dismantling of law faces major political challenges
After spending years calling for the dismantling of “Obamacare,” many Republicans have come to a stark realization: It might be all but impossible, politically, to do so while ignoring how it extended coverage to millions of uninsured Americans.
“If Republicans have accepted that everybody with pre-existing conditions are covered, that kind of dictates a lot of what you can and can’t do,” said Sen. Jeff Flake, R-Ariz., citing one of the key tenets of President Barack Obama’s signature 2010 health law. “The debate has moved, certainly, from where it was seven years ago.”
Sen. John McCain, R-Ariz., who attacked Affordable Care Act problems during his 2016 re-election campaign, said demands to just repeal the law are not feasible without a responsible replacement.
“We cannot abandon any group of Americans who have become accustomed to receiving health care,” McCain told The Arizona Republic. “The question is, how do you maintain it as affordable?”
Not all in their party agree, which
became evident when House Republicans unveiled their Affordable Care Act repeal bill last week to mixed reviews. Conservative GOP lawmakers were among the harshest critics, noting the plan is similar in structure to the ACA and dismissing it as “Obamacare Lite” or “RINOcare,” using the acronym for “Republican in Name Only.”
Arizona’s congressional delegation highlights how the situation has lawmakers off balance as President Donald Trump’s first high-stakes legislative battle takes shape. They must consider that opposing the plan would put them at odds not only with the president — and his Twitter account — but also with significant interest groups and donors who fund their campaigns, as well as their leaders in Congress, who can yield significant influence over their career path on Capitol Hill.
‘Studying’ the bill
House Speaker Paul Ryan’s bill eliminates the Affordable Care Act’s unpopular individual mandate that every American buy health insurance or pay a fine.
Like the ACA, the Republican plan prohibits insurers denying coverage for pre-existing conditions. It also leaves in place, for at least a few years, Obamacare’s expansion of Medicaid coverage for lower-income Americans.
Instead of ACA’s subsidies, the government under Ryan’s bill would help some people buy insurance through refundable tax credits. The credits would lead to some lower-income people receiving checks from the federal government.
The financial costs of the bill are not yet known.
Some conservative GOP lawmakers view the bill as too similar to the ACA. The credits are not only expensive, according to some Republican critics, they’re not much different than Obamacare’s subsidies.
The Republican proposal faces a tough sell. Democrats appear united in their opposition. That means, to send their plan to Trump’s desk, Republicans can lose no more than 21 House members and two senators.
By week’s end, no one officially crossed party lines, but four of Arizona’s five Republicans in the House and its GOP senators publicly withheld support. Three of the four House Democrats made clear they oppose Ryan’s plan, with the others balking at the rush to consider a bill whose financial and coverage effects were not yet known.
The common refrain was that the members were “studying” a bill fasttracked by House leaders.
As the week drew to a close, McCain and Flake — the state’s junior senator who faces re-election in 2018 — had not yet taken a position on Ryan’s House legislation.
Rep. Paul Gosar, R-Ariz., called it a “bad bill.”
The usually outspoken Rep. Andy Biggs, R-Ariz., stayed silent on the issue until late Friday, when he criticized the bill. And the fiscally conservative Club for Growth, which spent heavily in Biggs’ primary to help him win, opposes the measure.
Reps. Kyrsten Sinema and Martha McSally, who represent divided districts, were, like McCain and Flake, also exercising caution.
The Freedom Caucus
With four members, Arizona has an outsized presence in the Freedom Caucus, a group of 40 or more Republicans whose hard line on spending in the past has pushed the federal government to the brink of a shutdown. Only one of them, Rep. David Schweikert, offered support for the GOP plan.
He followed leadership and voted Thursday to move the bill out of the powerful Ways and Means Committee, of which he is a member.
But members of the Freedom Caucus made it clear the proposal falls well short of their desire to scrap the ACA and create a market-driven system.
In a written statement, Biggs said, “The health care package ... is an amendment — and not a clean repeal — to Obamacare . ... I campaigned on a clean repeal to Obamacare and a free-market, patient-centered alternative to truly lower the costs of insurance premiums, and I intend to work with my colleagues in the House to ensure that Americans have affordable and accessible health care options.”
Gosar rode the anti-Obamacare wave of 2010 to Washington. He has frequently cited his experience with the health-care system as a dentist to savage the ACA.
After being pressed by Majority Whip Steve Scalise, R-La., to side with Trump or Minority Leader Nancy Pelosi, D-Calif., Gosar bristled.
“My folks out in rural Arizona, they don’t have much choices. It’s too expensive for them to afford,” Gosar told The Hill. “So all of a sudden you’re going to see a very captive audience being driven from that competitive marketplace. And that’s why, to me, everything is all about re-creating that competitive market.”
A Gosar spokesman on Friday clarified that Gosar feels House Republican leaders and Trump are making an effort to listen to his concerns.
Rep. Trent Franks, also a Freedom Caucus member, was silent on the GOP plan last week. His spokeswoman did not respond to requests for comment on the
issue.
Whatever Franks doesn’t like about the plan, he is likely pleased it would defund Planned Parenthood, the healthservices organization reviled by many conservatives because it provides abortions. Franks has made his opposition to abortion a central pillar of his tenure in Congress.
“Can we agree that we’re on the same page and trying to get to the same outcome, and we disagree on how to get there? It’s not like we don’t have the same goals, which is people can get access to health care.” REP. MARTHA MCSALLY
Tough races ahead
These days, Flake is feeling the most political heat. He faces his first reelection test as a senator next year. Flake memorably got crosswise with Trump during last year’s campaign, earning the ire of the president’s supporters. Other Republicans are sizing up their chances for a possible challenge.
As a member of the House, Flake, whom the Club for Growth also supported in past campaigns, voted against the Affordable Care Act in 2010.
Flake said he sees pros and cons with the House repeal bill.
“Finally dealing with Medicaid as one of the three entitlement programs that are simply unsustainable” is one of the good parts, Flake told The Republic. “This puts at least some parameters around it.”
On the other side, Flake views the bill’s refundable tax credits as more taxpayer subsidies.
“We’ll see when CBO comes back how that scores, but it’s still pretty expensive,” Flake said, referring to the pending cost and coverage estimates by the Congressional Budget Office.
McSally, a Republican, and Sinema, a Democrat, both were guarded on the GOP plan last week. They are not fans of the ACA, and both preside over districts that are considered competitive, though each was comfortably re-elected last year. Both are also routinely mentioned as contenders for statewide office someday.
A spokesman for McSally said she is “encouraged” the GOP plan includes the provisions of the ACA she likes and noted she is “carefully reading the 123-page bill, is listening to local stakeholders and in the days ahead will work with House leadership for a viable solution” to the nation’s health-care challenges.
In an interview last month, she tried to frame the issue as one of structure, not ideology.
“Can we agree that we’re on the same page and trying to get to the same outcome, and we disagree on how to get there? It’s not like we don’t have the same goals, which is people can get access to health care,” she said.
McSally has called for a system where “people can have choice and options, and people with preexisting conditions are not one diagnosis away from going bankrupt.”
For her part, Sinema rejected the race to pass the GOP bill without knowing its cost and how many people would be covered. “I’ve been very, very critical of the ACA, but I do believe that if you are going to repeal it, you have to have a thoughtful replacement that ensures affordability and accessibility,” she said in an interview before the Republican plan was released. “I’m very practical, and I have no ideology connected to the solution here . ... I don’t have any predetermined have-tos on a list.”
While McSally and Sinema held back their views, Rep. Tom O’Halleran, D-Ariz., who won the state’s closest congressional race last November, did not.
“This plan is neither affordable, nor does it provide quality care for the vast majority of Arizona families,” O’Halleran said.
The ACA has outsized importance in his district because it permanently authorized Indian Health Services.
Safe seats
Reps. Ruben Gallego and Raúl Grijalva, who represent safe Democratic districts, have acknowledged changes are needed to the ACA. But they have drawn the line against any changes that would cut coverage.
“I don’t think it’s enough to say no to Trump,” Grijalva said. “You have to be able to tell your constituents there was a better alternative.”
Having just won a new six-year term, McCain isn’t feeling political pressure, either. But he does want to uphold his word to Arizona voters by fixing the problems created by the Affordable Care Act.
“The reality we’re facing is that Obamacare is unraveling,” McCain said. “In Arizona, we only have one provider and well over 100 percent inflation in premiums. Obamacare, as it is, is not sustainable, so we have to work to fix it.”
McCain hasn’t come to a conclusion about the House GOP repeal bill but said it will face unlimited amendments when it comes to the Senate.
He said he won’t go along with conservative efforts to force an outright repeal without a replacement program.
“That’s not what I campaigned on. I said I would repeal and replace,” McCain said. “If I went along with that, I would be contradicting what I told the people of Arizona when I was running for reelection. So when these individuals say just repeal it, that’s not what we told the American people we would do.”
USA TODAY reporter Eliza S. Collins contributed to this article.
ON HEALTH-CARE DEBATE