The House passed a 2017 budget Friday that lays the groundwork for dismantling Obamacare, brushing aside intra-GOP anxiety and defiant Democrats to launch the repeal-and-replace strategy staked out by President-elect Donald Trump.
Nine Republicans balked at the politically thorny plan — the budget doesn’t balance, and the party hasn’t coalesced around a health bill of its own. But their defections weren’t nearly enough to tilt the 227-198 vote, which imposes a Jan. 27 deadline for crafting legislation that guts the Affordable Care Act.
“The ’Unaffordable’ Care Act will soon be history!” Mr. Trump posted on Twitter before the vote.
The Senate approved the plan early Thursday on a 51-48 vote that brought in support from all but one Republican in the chamber, clearing the way for an eventual repeal vote that cannot be filibustered by Democrats.
The path forward is fraught with political risk for Republicans, who’ve railed against Obamacare for nearly seven years and promised 2016 voters they would deliver “relief” from soaring rates and dwindling choices under the program.
Party leaders are using a fast-track budget process to repeal and replace as much of the law as they can in the first several weeks of Mr. Trump’s administration. And they’re counting on the incoming president to issue administrative actions that smooth the transition away from Obamacare.
Yet Republicans are still mulling a legislative alternative, emboldening Democrats who say their political rivals are jumping off a cliff without a safety net for 20 million people who gained coverage under Obamacare, which expanded Medicaid coverage for the poor in 31 states and doles out taxpayer-funded subsidies to qualified persons seeking private plans on web-based exchanges.
The say repeal without a replacement will also ripple through the economy, particularly in the health sector, as patients show up for medical care with no way to pay for it.
If the GOP has its way, “the American people will be screwed,” said Rep. Hakeem Jeffries, New York Democrat. “People in Michigan, Pennsylvania, Wisconsin, Ohio — screwed. Seniors in Florida — screwed. People on the West Coast and the East Coast — screwed. People in Appalachia and rural America — screwed.”
Mr. Obama and his party allies say Obamacare could be fixed by adding a government-run plan, or “public option,” to improve competition in the exchanges, or boosting the taxpayer-funded subsidies to entice more people to sign up.
GOP leaders have rejected both ideas as “more Obamacare.” Instead, their election-year blueprint calls for replacing Mr. Obama’s heavy federal mandates with a plan that doles age-based tax credits and unleashes market forces to entice people into health coverage, while setting up high-risk pools to take care of sick customers who’ve been priced out of the individual insurance market.
They said insurance rates and deductibles are spiraling out of control under Obamacare, even as the number of companies offering plans in many counties is dwindling. A third of counties have just a single active insurer, the GOP says.
“My colleagues, this experiment has failed. This law is collapsing as we speak. And we have to step in before things get even worse,” said House Speaker Paul D. Ryan, urging his troops to support the budget that opens the door to repeal.
The speaker of the House rarely votes, but Mr. Ryan put himself on record Friday in favor of the budget, underscoring the magnitude of the effort.
Yet a mix of conservatives and GOP centrists voted “no,” citing concerns over spending or the way forward on health care: Reps. Justin Amash of Michigan, Charlie Dent of Pennsylvania, Brian Fitzpatrick of Pennsylvania, John Katko of New York, Raul Labrador of Idaho, Walter Jones of North Carolina, Tom MacArthur of New Jersey, Thomas Massie of Kentucky and Tom McClintock of California.
While there are no hard deadlines for replacing the law, Republicans say there will be a smooth transition to a GOP overhaul that will be vetted by Capitol Hill committees and moved in pieces, rather than one large bill.
Mr. Trump has egged them on, pressuring the party to repeal and replace Obamacare “essentially simultaneously” within weeks of his swearing-in, though that timeline appears to be unrealistic.
GOP leaders hope to emerge from a post-inaugural retreat this month with more details, though Senate Republicans who hold 52 seats in the upper chamber will need to win support from at least eight Democrats to overcome a filibuster of any replacement.
As it stands, the parties are bitterly divided — no Democrats in either chamber voted for the budget that unlocks the door to repeal.
Senate Minority Leader Charles E. Schumer, New York Democrat, says Republicans are heading into a “boxed canyon” and should come to the negotiating table before it’s too late.
Democratic state leaders have also urged Republicans to pump the brakes on repeal.
“Before you vote to repeal the ACA, every American has the right to know exactly what, if anything, you intend to replace it with,” California Insurance Commissioner Mike Jones wrote Thursday to House Majority Leader Kevin McCarthy. “A vote to repeal the ACA, without a specific replacement, would create crippling uncertainly, causing instability in the insurance market which could bring about the collapse of our health care system.”
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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