GOP Obamacare replacement plan already in jeopardy

WASHINGTON — A day after it was unveiled, a Republican House plan to replace the Affordable Care Act seemed in jeopardy Tuesday as opposition mounted from influential conservative groups and key GOP lawmakers, who derided the legislation as “Obamacare 2.0.”

The Trump administration and congressional supporters warned opponents within their party that the bill is the only means Republicans have to keep their long-held promise to repeal and replace the Affordable Care Act.

“If you like your Obamacare you can keep it,” Vice President Mike Pence told Republican senators after meeting with them for a weekly luncheon. “The simple fact is Obamacare must go.”

House Republican leaders made clear they would attempt to move the plan rapidly through the House and send it to the Senate for passage, without hearings or expert testimony in either chamber.

But conservative Republicans ripped the plan for keeping intact regulations in the Affordable Care Act that they say have caused insurance prices to rise and for providing a “new entitlement” in the form of tax credits to help people buy insurance.

Given the swift opposition to the bill and a glaring lack of a political groundswell in its support, the plan’s future remains an open question. If the legislation fails to gain traction, the struggle over fulfilling the bedrock promise of President Trump and congressional Republicans to repeal the Affordable Care Act could consume the Republican agenda for weeks if not months, delaying action on tax reform and grinding the new administration’s legislative agenda to a halt.

With Democrats unlikely to support the bill in either chamber of Congress, the plan can’t afford to lose more than three Senate Republicans or roughly 20 GOP House members. So far, at least two Republican senators — Rand Paul of Kentucky and Mike Lee of Utah — have signaled they may not go along with it.

The House bill would replace the Affordable Care Act’s subsidies to help people buy health insurance with a system of tax credits, but it would retain the most popular provisions of Obamacare such as requiring insurance companies to cover people with pre-existing conditions and allowing children to stay on their parents’ plans until age 26. It would replace the current law’s mandate to buy health insurance, but would allow insurers to charge a 30 percent penalty to people who let their insurance lapse and then try to buy a new policy.

The bill lifts a welter of taxes on high-income individuals and other sources of revenue that pay for the current system. The legislation also promises, beginning in 2020, to restrict the government’s big expansion of Medicaid that has allowed states such as California to cover millions of low-income workers. The restriction will not apply to people who are already being helped by the expansion by then.

On Tuesday, conservative lawmakers and outside groups ridiculed the plan as “Obamacare Lite,” “Ryancare,” after House Speaker Paul Ryan, or “RINO-care,” as in Republican in name only, even as the president and other party leaders said it was just a starting point.

“We’re going to do something that’s great,” Trump said after emerging from a White House meeting with GOP House and Senate leaders. “And I am proud to support the replacement plan.”

Trump said the plan “follows the guidelines I laid out in my congressional address. … This will be a plan where you can choose your doctor, and this will be a plan where you can choose your plan. And you know what the plan is. This is the plan.”

But Rep. Jim Jordan of Ohio, a member and former chairman of the conservative Freedom Caucus, called the bill a slimmed-down version of Obamacare and criticized his colleagues for offering it as “the first thing we bring a Republican president.”

Paul said Republicans are united on repeal, “but we are divided on a replacement.”

Jordan, Paul and a raft of other conservative lawmakers said at a news conference that they would introduce a straight repeal bill Wednesday and work on a replacement later. They suggested a more free-market-style alternative, adding that the acid test for any legislation is that it must lower the cost of policies.

Democrats also criticized the plan, saying its proposed tax credits are too skimpy and would force millions to lose their insurance or accept inadequate policies. They also said the legislation is poorly thought out.

“I don’t think it adds up,” said Rep. Frank Pallone, of New Jersey, the top Democrat on the Energy and Commerce Committee. “I don’t know if the whole thing collapses.”

The tumult appears to be pushing Democrats toward an embrace of so-called single-payer health care in which the government provides and pays for universal coverage, an idea President Barack Obama rejected as too radical.

“We should have gone for Medicare-for-all,” said Rep. Ro Khanna, D-Fremont. Such a plan would have been simpler, more popular and “more intellectually consistent,” Khanna said. “I would go so far as to say any Democrat who doesn’t embrace the vision of Medicare-for-all and single payer should not be the nominee of our party.”

The House Ways and Means and Energy and Commerce committees will begin voting on the legislation Wednesday, without hearings or an analysis of its cost, coverage or other effects by the nonpartisan Congressional Budget Office, an official agency that helps Congress understand the fiscal and economic consequences of legislation.

House Minority Leader Nancy Pelosi, the architect of the Affordable Care Act, was quick to react to the unusual move. The San Francisco Democrat denounced the lack of hearings and of a CBO analysis. To underscore her point, she provided a chart showing that the House held 79 public hearings, and the Senate 58 hearings on the Affordable Care Act, adopted nearly 150 Republican amendments on the final legislation, and held roughly 3,000 town hall meetings.

Senate Republican Whip John Cornyn of Texas dismissed the need for hearing and told reporters that the legislation “will probably come straight to the floor” of the Senate, because Republicans have already had a “lot of consultation” with each other.

The simple question facing the GOP is, he said, “Are we going to keep our promises or not?”

But outside conservative groups and Democrats were swift and brutal in their assessment.

Avik Roy, a leading Republican health care expert who advised former presidential nominee Mitt Romney, issued a critique titled, “House GOP‘s Obamacare Replacement Will Make Coverage Unaffordable For Millions — Otherwise, It’s Great.”

Dan Holler, a vice president at Heritage Action for America, a conservative political action committee, added his voice to the criticism that the GOP bill leaves in place the current law’s regulations that, he said, drive up the cost of insurance, while creating “a new entitlement” in the form of tax credits, rather than straight subsidies, to help people afford it.

Democrats quickly labeled the GOP plan “Trumpcare,” with Sen. Chris Murphy of Connecticut calling it a “dumpster fire” that “was written on the back of a napkin.” Republicans acknowledged that they expect zero Democratic support.