GOP lead­ers look to early health care bill, de­tails vague

The Hazleton Standard-Speaker - - FRONT PAGE - By ALAN FRAM

WASH­ING­TON — Un­der mount­ing pres­sure from Don­ald Trump and rankand-file Repub­li­cans, con­gres­sional lead­ers are talk­ing in­creas­ingly about chis­el­ing an early bill that dis­man­tles Pres­i­dent Barack Obama’s health care law and be­gins to sup­plant it with their own vi­sion of how the na­tion’s $3 tril­lion-a-year med­i­cal sys­tem should work.

Yet even as Repub­li­cans said they will pur­sue their para­mount 2017 goal ag­gres­sively, lead­ers left plenty of wig­gle room Thurs­day about ex­actly what they will do. Their cau­tion un­der­scored per­sis­tent di­vi­sions over how to re­craft a law they’ve tried eras­ing since its 2010 en­act­ment, plus their de­sire to avoid pan­ick­ing the 20 mil­lion peo­ple who’ve gained cov­er­age un­der Obama’s over­haul or un­set­tling health in­sur­ance mar­kets.

In an in­ter­view with con­ser­va­tive ra­dio host Mike Gal­lagher, House Speaker Paul Ryan, R-Wis., said the ini­tial re­peal and re­place leg­is­la­tion will be “the pri­mary part of our health care pol­icy” and would be fol­lowed by other bills. Later, he told re­porters at the Capi­tol that while Repub­li­cans will work quickly, “We’re not hold­ing hard dead­lines, only be­cause we want to get it right.”

Se­nate Ma­jor­ity Leader Mitch McCon­nell, R-Ky., said the early re­peal bill would “be­gin to make im­por­tant progress.” He said Repub­li­cans “plan to take on the re­place­ment chal­lenge in man­age­able pieces, with step-by-step re­forms.” He set no timetable.

“Re­peal­ing and re­plac­ing Oba­macare is a big chal­lenge. It isn’t go­ing to be easy,” McCon­nell added.

The lead­ers spoke a day be­fore the House plans to give fi­nal approval to a bud­get that would shield the forth­com­ing re­peal-and-re­place bill from a Demo­cratic fil­i­buster in the Se­nate.

Strip­ping Democrats of their abil­ity to end­lessly de­lay that bill — a tac­tic that takes 60 votes to thwart — is cru­cial for Repub­li­cans, who have just a 52-48 edge in the Se­nate. That cham­ber ap­proved the bud­get early Thurs­day by a near party­line 51-48 vote, draw­ing a Twit­ter thumbs-up from Trump.

“Con­grats to the Se­nate for tak­ing the first step to #Re­pealOba­macare — now it’s onto the House!” the pres­i­dent-elect tweeted.

Trump, who en­ters the White House next Fri­day, has pressed Repub­li­cans in re­cent days to act quickly on an­nulling and re­shap­ing Obama’s law. GOP lead­ers seem to be tak­ing his urg­ings to heart, though some have sug­gested his de­sire for speed doesn’t match Congress’ vin­tage lack of agility.

Asked how quickly law­mak­ers could send Trump a bill, No. 2 Se­nate Repub­li­can leader John Cornyn of Texas said, “The most im­por­tant thing is when do you get 218 votes in the House and 51 votes in the Se­nate,” the ma­jori­ties needed for pas­sage.

“He’s not a crea­ture of this place so there’s al­ways a bit of a learn­ing curve,” said the No. 3 Se­nate GOP leader, John Thune of South Dakota.

Obama’s law, which he con­sid­ers a tro­phy of his soon-to-end pres­i­dency, has pro­vided health care sub­si­dies and Med­i­caid cov­er­age for mil­lions who don’t get in­sur­ance at work. It has re­quired in­sur­ers to cover cer­tain ser­vices like fam­ily plan­ning and peo­ple who are al­ready ill, and curbed rates the sick and el­derly can be charged.

GOP lead­ers hope to use their first bill to void and re­write as much of Obama’s law as they can, but so far they’ve pro­vided lit­tle de­tail. Cornyn said in a brief in­ter­view Wed­nes­day that the early leg­is­la­tion will “push some of the re­spon­si­bil­ity and re­sources down to the states and give them more flex­i­bil­ity,” such as for Med­i­caid.

Repub­li­cans want to end the fines that en­force the statute’s re­quire­ments that many in­di­vid­u­als buy cov­er­age and that larger com­pa­nies pro­vide it to work­ers — man­dates that ex­perts say were needed to sta­bi­lize in­sur­ers’ rates. They’d like to ex­pand health sav­ings ac­counts, erase the taxes Obama’s statute im­posed on higher-in­come peo­ple and the health care in­dus­try, elim­i­nate its sub­si­dies that help peo­ple buy poli­cies and pare back its Med­i­caid ex­pan­sion.

But they face in­ter­nal dis­agree­ments over pol­icy, such as how to pay for their new statute and how to pro­tect con­sumers and in­sur­ers dur­ing what may be a two- or three-year phase-out of Obama’s over­haul.

They also must heed Se­nate rules for­bid­ding pro­vi­sions that don’t di­rectly af­fect taxes and spend­ing from be­ing safe­guarded from fil­i­busters. That means re­peal­ing im­por­tant parts of the law — like the re­quire­ment that in­sur­ers of­fer cov­er­age to all cus­tomers in­clud­ing the most ill — would have to await later bills that would need Demo­cratic sup­port.

Democrats have so far solidly op­posed the GOP ef­fort. But one in­flu­en­tial con­ser­va­tive health care au­thor­ity warned Repub­li­cans Thurs­day that it would be best to work with their ri­vals.

“Bi­par­ti­san sup­port for what­ever is as­sem­bled is the best way, and prob­a­bly the only way, to en­sure that what passes in 2017 is ac­cepted by the pub­lic” in a way Obama’s law was not, James Capretta, a fel­low at the Amer­i­can En­ter­prise In­sti­tute who for­merly worked for Pres­i­dent Ge­orge W. Bush, wrote Thurs­day in Na­tional Re­view On­line.

CLIFF OWEN/Associated Press

Se­nate Ma­jor­ity Leader Mitch McCon­nell of Ken­tucky pauses dur­ing a news con­fer­ence on Capi­tol Hill in Wash­ing­ton. The Repub­li­can-led Se­nate is poised to take a step for­ward on dis­man­tling Pres­i­dent Barack Obama’s health care law de­spite anx­i­ety among some GOP sen­a­tors who fear they still haven’t come up with an al­ter­na­tive.

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