House Speaker Paul D. Ryan on Friday will launch a self-described “rescue mission” to save America from rising premiums and dwindling choices under Obamacare, hoping he can rally enough Republicans to back the simultaneous “repeal and replace” approach carved out by President-elect Donald Trump.
His first test will be a vote to approve a 2017 budget that paves the way for a speedy repeal — even though a replacement plan is not in hand.
The Senate passed the budget on a 51-48 vote early Thursday, earning support from all but one Republican in the chamber. The House, however, could be tricker, with perhaps several dozen Republicans signaling that they are not sold on the outline of the repeal-and-replace their leaders have in mind.
The way Mr. Ryan sees it, voters tasked Mr. Trump and the Republican-led Congress with saving them from insurance premiums and deductibles that are soaring on Obamacare’s exchanges, even as the number of companies offering plans in many places is dwindling. A third of counties have just a single active insurer.
“We are on a rescue mission to prevent Obamacare from making things even worse,” said Mr. Ryan, Wisconsin Republican.
Yet there is little margin of error for Republicans, who railed against Mr. Obama for years without rallying around an alternative, only to be tasked with following through on their repeal-and-replace strategy.
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“They couldn’t have been more clear that they are going to use their new majority and White House control to get rid of Obamacare. But they have created an information vacuum by not being able to tell us exactly what they are going to replace it with and when,” said Robert Laszewski, a health care policy consultant from Alexandria, Virginia. “As a result, and as much as it is misleading, the Democrats have been able to rail about 20 million people losing their insurance turning the Republican plans for repeal into a pinata. The Republicans are really losing the messaging here.”
Mr. Ryan told reporters that Republicans have no hard deadlines for replacing the law, though they plan to offer a smooth transition from Obamacare to a system that will be vetted by Capitol Hill committees and move in pieces, rather than in one large bill.
Democrats are largely powerless to stop the majority from dismantling the law. The House’s 2017 budget vote Friday would prevent a filibuster in the Senate, but Democrats are betting on a public outcry to bring Republicans to the negotiating table.
“Republicans are in the cut-and-run mode,” said House Minority Leader Nancy Pelosi, California Democrat. “But I do hope that we can find a place to save the principles and value of the Affordable Care Act in a way that has results and is practical.”
Congressional Democrats and President Obama say the Affordable Care Act could be fixed by adding a government-run plan, or “public option,” to improve competition in the exchanges, or by boosting the taxpayer-funded subsidies to entice more people to enroll.
Republicans have rejected those ideas, saying they amount to “more Obamacare,” though Senate Minority Leader Charles E. Schumer, New York Democrat, is gambling that Republicans will enter a “boxed canyon” and seek bipartisan help.
“Turn back before it’s too late, because you’ll regret moving forward,” he warned Senate Republicans ahead of the budget vote.
Republican leaders said Democrats are better off supporting a shift away from Obamacare, which they said isn’t salvageable.
Mr. Ryan said soaring premiums will chase away even more of the young and healthy people needed to make the health care law’s economics work.
Republicans are using an arcane process known as budget reconciliation to knock out as much of the 2010 law as they can, perhaps by late February, while relying on Mr. Trump’s team to issue executive actions that smooth over the transition.
The party will then consider replacement measures that have been outlined in various blueprints and bills, though any legislation would require support from eight Senate Democrats to overcome a filibuster.
“I do hope and believe that some of this can and should be bipartisan,” Mr. Ryan said. “But if people are going to be partisan and so ideological to try and cling to the failure of Obamacare, which is doing damage in people’s lives, then, you know, shame on that.”
Analysts say Republicans will inevitably run into problems while they tackle something as complex as health care reform but have little room for blame now that they are in control.
“Republicans own health care due to their control of the presidency, House and Senate. If things fall apart based on their repealing Obamacare, critics will shift the blame to them,” said Darrell West, director of governance studies for the Brookings Institution. “They face risks in terms of hospital finances, a rise in people without insurance, and costs escalating. This could create a political nightmare for the GOP.”
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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