Congress could gut Obamacare within weeks following the Senate’s vote — just before 1:30 a.m. Thursday — on a budget bill that clears the way for repeal. The House is expected to vote on the same measure Friday.
The bill aims for four committees in the House and Senate to write legislation by Jan. 27 that would collectively dismantle the Affordable Care Act. GOP leaders are hoping to tee up a vote on the proposal shortly thereafter.
A small but growing number of Republicans, however, is wary of moving without a replacement, a concern that could jeopardize the Jan. 27 deadline.
Experts have warned that repealing the law without a replacement could cause massive disruption to the nation’s individual health insurance market and millions of Americans could lose their coverage.
In Georgia, more than 480,000 people have already selected Obamacare coverage for 2017 with 20 days still to go until the end of open enrollment. They join the more than 11.5 million Americans who have signed up so far for coverage through the federal and state insurance exchanges.
Obama officials have assured consumers those health plans will remain good through the end of this year.
But what comes after that is anyone’s guess.
Repeal and delay?
Repeal is a perilous task for GOP leaders.
They have waited seven years for a chance to put their own stamp on health care policy and replace a law they have long vilified. But they are now responsible for delivering on a bold and substantial campaign pledge with little margin for error.
Divisions within the party start with whether to repeal the law right away or wait until there’s a replacement ready. A handful of Senate Republicans has come forward over the past two weeks to express reservations about moving too quickly.
House Speaker Paul Ryan sought on Thursday to reassure Republicans in his chamber that “repeal and replace” would be carried out with care.
“This will be a thoughtful, step-by-step process,” Ryan said, according to a Washington Post report Thursday evening. “We’re not going to swap one 2,700-page monstrosity for another… . We’re going to do this the right way.”
The GOP is unified on the broad principle that their alternative won’t force people or companies into things they don’t want to do. But the party has not coalesced around a single replacement plan.
Georgia Republican Johnny Isakson saidWednesday that it is “unsustainable and impractical and it’s wrong for us to say we’re going to repeal Obamacare without replacing it with a plan that we know works.”
Sen. David Perdue of Georgia meanwhile, supports repealing now, even if a substitute isn’t immediately available.
“I know what’s happening right now behind the scenes, and that’s an active conversation about the replacement pieces,” Perdue said in an interview.
“I’m quite anxious to have an active and open debate because we’re going to have to have Democrat cooperation to actually get some of the replacements done,” Perdue added.
Democrats have said they won’t aid the repeal effort, although some moderates have indicated they’d be willing to help negotiate a replacement.
Meanwhile, President-elect Donald Trump on Wednesday told reporters his new administration would file a plan to repeal the Affordable Care Act shortly after Tom Price, the Georgia congressman Trump nominated to lead the Department of Health and Human Services, is confirmed by the Senate.
“We’re going to be submitting as soon as our secretary is approved, almost simultaneously, shortly thereafter, a plan,” Trump said during a press conference Wednesday. “It will be repeal and replace. 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.”
The first of two Senate confirmation hearings for Price is scheduled for Wednesday.
‘There’s too much uncertainty’
He is expected to take an active role in helping Republicans get on the same page, given his close relationship with Speaker Paul Ryan and credentials as a doctor and longtime lawmaker who has authored an Obamacare replacement plan of his own.
In Georgia, roughly 85 percent of people with Obamacare coverage receive tax subsidies to help them afford the premiums. Without that aid, many would likely lose their health insurance.
It’s too soon for insurers and health providers to make any major decisions, said Bill Custer, a health care expert at Georgia State University.
“There’s too much uncertainty,” Custer said. “The best move is to do nothing at this point. You just have no idea what’s going to happen in the next couple of weeks.”
None of the replacement plans proposed by Republicans comes close to covering the same number of people that the Affordable Care Act has, he added.
“Right now, we’ve seen a lot of high-level rhetoric, and the effect is going to be in the details,” Custer said.
The repeal vote also places into question what, if anything, Georgia lawmakers will do to extend health coverage to the state’s roughly 1.4 million uninsured residents. Georgia has the third-highest rate of uninsured in the nation, behind only Texas and Alaska, Census Bureau data shows.
In recent months, state Republicans increasingly began to push to expand Medicaid under the health care law, albeit in a more conservative-friendly way than traditional expansion. Expanding Medicaid as is would extend health coverage to an estimated 600,000 low-income Georgians and bring in billions of dollars in new federal funding to help support the state’s ailing rural health care system.
But after the Nov. 8 election, the Medicaid expansion discussion ground to a halt.
Top state Republicans have said they hope to play a role in how Congress shapes a replacement for Obamacare. GOP Senate leaders said last week that the creation of a “repeal Obamacare” task force will be a top priority under the Gold Dome this legislative session.
Georgia has strong connections in Washington, said state Sen. Renee Unterman, R-Buford, who is a member of the task force.
“My main goal is not to be regressive but to be progressive,” she said. “We’re glad the system’s changing. We just want to be a part of it.”
What comes next?
The Senate’s 51-48 party-line vote on the budget bill on Thursday was just enough for the measure to squeak through the chamber. The legislation now heads to the House, which is expected to cast its vote on Friday.
Isakson and Perdue both voted in favor of the bill after seven hours of back-to-back votes, part of a byzantine Senate ritual known as “vote-a-rama.”
“The American people have called on Congress to act and finally bring relief from Obamacare,” said Senate Majority Leader Mitch McConnell, R-Ky.
The measure the Senate passed does not repeal the Affordable Care Act on its own — but it does mark a path forward for a party hell-bent on replacing Barack Obama’s signature policy achievement.
The budget bill tells four committees – two in the House and two in the Senate – to each write bills over the next two weeks that cut at least $1 billion from the deficit over a decade. From there, the House and Senate Budget committees will cobble the measures together into a mega repeal package that will strike at the heart of the 2010 health care overhaul. Presumably some of the changes would not take effect for years, but experts say that even a delayed effect — without a clear replacement plan in place — could result in chaos in the health care market.
The reason Republican leaders chose to use the arcane budget process to repeal Obamacare is that it unlocks a special procedure that enables them to act with only 51 votes in the Senate instead of the usual 60. The math is critical since there are currently 52 Republican senators, but that also means that leaders can afford to lose only two members of their own party before their dream of repealing and replacing Obamacare is shredded.