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ACA Repeal Bill Goes to Obama, but What About Replacement?

(Bill Clark/CQ Roll Call)

Republicans on Wednesday celebrated achievement of a long-held goal to send a bill repealing the Affordable Care Act to President Barack Obama's desk, but now they must decide whether they can, or should send him an alternative health care plan.  

That question has many different answers, depending whom you ask, and will likely not be decided until after a bicameral GOP retreat in Baltimore on Jan. 13-15. But House Republicans say they are committed to at least putting out an alternative plan to show voters what Congress could do with the help of a Republican president in 2017.  

"We’re going to show our hand; it’s not going to be cards close to vests," said House Energy and Commerce Chairman Fred Upton, whose panel shares jurisdiction over health care with the Ways and Means and Education and the Workforce committees.  

Speaker Paul D. Ryan, during a speech at the Library of Congress on Dec. 3, said that in 2016 Republicans would "unveil a plan to replace every word of Obamacare." He noted there are a lot of ideas on how to do that, but said conservatives agree "government should encourage personal responsibility, not replace it."  

When asked about an alternative Wednesday, Ryan said only, "Just wait."  

Ryan spent a lot of time early last year when he was chairman of the Ways and Means Committee working with Upton, a Michigan Republican, and Education and the Workforce Chairman John Kline, R-Minn., on a replacement plan. Their working group was tasked with preparing for a possible Supreme Court decision overturning the Affordable Care Act tax subsidies, but when the court ruled to uphold the subsidies, their discussions largely stopped.  

"It’s in a drawer," Kline said Wednesday when asked what happened to that work. "We’ve got a lot of draft stuff."  

Upton said those draft materials closely resemble a plan he released with Sens. Richard M. Burr, R-N.C., and Orrin G. Hatch, R-Utah.  

Putting together a widely endorsed health care alternative, as seems to be Ryan's goal, will be much more complicated.  

"Here's where we're blessed: we've got a number of replacement plans from some very smart, informed leaders in the House," Ryan's successor on Ways and Means, Chairman Kevin Brady, R-Texas, said. "Part of our challenge will be working among the committees in regular order, each tacking their part of the replacement plan and putting that together. That's going to be part of the discussion at the retreat."  

While much of discussion at the retreat will likely focus on a full Republican health care alternative, Rep. Pat Tiberi, R-Ohio, chairman of the Ways and Means Health Subcommittee, told Roll Call he would like to work with Democrats on more incremental changes that can possibly pass this year. He said he was having dinner Wednesday night with Democrats and Republicans to begin those discussions.  

"My intent is to make law, not to make noise," Tiberi said. "Nobody believes we’re going to get a 60-vote threshold in the Senate even if we pick up the White House, so we’re still going to have to deal with Democrats."  

Democrats have expressed willingness to tinker with small parts of the law, but they have always stood with Obama against repeal efforts and expressed doubt the GOP will ever produce a full replacement.  

"We're waiting. And it's never appeared," Ways and Means ranking member Sander M. Levin, D-Mich., said. "And we've been pushing them. They've always said, 'It's going to happen.' But it never has happened. So we'll see."  

Even some Republicans are doubtful that an alternative will materialize. "The reason it’s difficult to come out with a plan is because there’s different ideas on what the right plan is. People are all over the map on that,” House Freedom Caucus founding member Raul R. Labrador, R-Idaho, said.  

"Replacing Obamacare is just actually replacing it with another government-run program," he added, "and I think some of us as conservatives don’t want the government to be running that."  

At the same time, other conservative members have been frustrated with leadership's failure over the past few years to move GOP ideas forward. "Those plans have been developed, but that’s part of the friction," HFC member Steve Pearce, R-N.M., said.  

For now, members believe Ryan when he says things will be different this year. "I think you’re going to see the replacement pieces coming forward," Pearce said.  

If Republicans do release an ACA alternative in 2016, election-year politics may prevent it from moving through the legislative process. Ryan has demurred when asked if Republicans would advance their ideas through blueprints or actual legislation, saying it's up to members to decide.  

"Whether we have a floor vote or whether we lay out principles, people are going to know what we stand for," Upton said. "And we need to do that. And we will."  

Bridget Bowman contributed to this report. 

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