Health Coverage Questions Persist for Republicans

Chances of House GOP blueprint passing the Senate remain unclear

Speaker Paul D. Ryan told reporters the House GOP health care measure will be introduced after the Presidents Day recess but it might face opposition from Republicans in the Senate. (Bill Clark/CQ Roll Call file photo)
Speaker Paul D. Ryan told reporters the House GOP health care measure will be introduced after the Presidents Day recess but it might face opposition from Republicans in the Senate. (Bill Clark/CQ Roll Call file photo)
Posted February 22, 2017 at 5:00am

As Republican lawmakers face questions from constituents and colleagues about their plans to repeal and replace the 2010 health care law, there are few answers available, starting with what kind of legislation can pass the Senate. 

Republicans do not need Democratic support to undo much of the law, since they will move the legislation through the budget reconciliation process that only requires majority support in the Senate. But with only 52 Republican senators, the GOP plan will have to get support from both their conservatives and moderates, and it’s not clear what can get everyone onboard.

“We made a promise to the voters that we would repeal and replace Obamacare, and we’ve got to keep that promise,” said Senate Majority Whip John Cornyn, when asked how Republicans will keep their caucus together.

“So that’s going to, I think, be what forces everybody to make a decision,” the Texas Republican said.

Kicking into gear

Congressional staffers are working on legislation this week, and consulting with the Senate parliamentarian, to make sure the ideas pass the chamber’s reconciliation rules.

Lawmakers face pressure, though, from constituents as well as insurance companies, which must decide whether to participate in the exchanges created by the health care law. So they are looking to move quickly.

Speaker Paul D. Ryan told reporters the repeal and replace measure will be introduced after the Presidents Day recess.

Asked if that meant the week of Feb. 27, the Wisconsin Republican demurred, saying they were waiting on cost estimates from the Congressional Budget Office and the Joint Committee on Taxation.

Ryan did not outline a time frame for committee markups or floor action. Texas Republican Rep. Bill Flores said committees will begin marking up the reconciliation legislation the week of Feb. 27, with floor action expected in April.

Sen. Lamar Alexander, chairman of the Health, Education, Labor and Pensions Committee., said last week he had spoken with Ryan and expects the House to move on the legislation in early March.

“There will be several more steps before we have a final piece of legislation,” the Tennessee Republican told reporters. He added that the bill will include input from senators and the Trump administration.

President Donald Trump signaled at a Florida rally last Saturday that his administration may unveil its own plan in “a couple of weeks.”

House lawmakers have an outline for their plan, which was presented at the GOP conference meeting last week. Health and Human Services Secretary Tom Price and Ryan met with GOP senators last week as well, but those senators are waiting for details.

“It’s very difficult to assess a plan when we don’t know what’s in it,” said Maine’s Susan Collins.

Senate Finance Chairman Orrin G. Hatch of Utah drew on a sports analogy, characterizing the process as being in “the middle of the first half.”

Alexander said Congress must legislate this year to stabilize the insurance market. But Senate Majority Leader Mitch McConnell did not commit to taking it up this year, saying at a recent press conference that the chamber will act “just as soon as we have the votes.”

Trouble in the Senate

Another Senate obstacle could be over Planned Parenthood.

Ryan has said the House proposal will strip funding for the women}s health organization, but moderates such as Collins have pushed back. 

Lawmakers are also wrestling with how to address the 31 states and the District of Columbia that have expanded Medicaid under the health care law.

The House GOP blueprint would phase out reimbursements for states that expanded Medicaid, but it doesn’t delineate how the program would be funded long-term. One proposal centers on so-called per capita caps, which would allot funds for each enrollee in a state. 

There are 21 Republican senators from states that expanded Medicaid, whose support would be key for any legislation. Several of them, as well as their governors, are concerned about losing Medicaid funds and coverage for people insured through the program.

Top lawmakers will be speaking with governors about how to address the issue when the National Governors Association conducts its winter meeting in Washington this weekend. 

Alexander insisted that lawmakers are proceeding in an orderly fashion.

“We’re not writing the bill in public. We’re writing the bill together, so it’ll be changing a lot as it goes along, but it’s a very good beginning,” he said.

Lindsey McPherson, Erin Mershon, Niels Lesniewski, and John T. Bennett contributed to this report.