The Washington PostDemocracy Dies in Darkness

Getting rid of Obamacare may take longer than Trump plans

President-elect Donald Trump and House Speaker Paul D. Ryan of Wisconsin pose for photographers after a meeting in the speaker’s office on Capitol Hill in Washington on Nov. 10. (AP Photo/Alex Brandon)

President-elect Donald Trump and congressional Republicans promised during the campaign to quickly repeal and replace President Obama’s signature health-care law if they controlled Washington.

Now GOP lawmakers are predicting it could take years to fulfill that pledge.

Republican leaders in the House and Senate on Tuesday began emphasizing that even if Congress moves quickly on a vote to repeal the Affordable Care Act, it will take time to ease people out of its programs and replace it with their long-promised alternative.

“There will be a multiyear transition into the replacement,” said Senate Majority Whip John Cornyn (R-Tex.). “This is a failed piece of legislation and it is coming apart at the seams, but it is going to take us awhile to make that transition from the repeal to actually replacing it.”

Cornyn and other top Republicans said it will take time to move people who use Obamacare programs such as state and federal exchanges into the new health-care system they have promised to create. That process is further complicated by the fact that Republicans have never released a comprehensive proposal for how they would replace the system.

“We know that to correct it is going to take time, it’s just that simple,” said Senate Finance Committee Chairman Orrin G. Hatch (R-Utah).

The acknowledgment by Republicans that “repeal and replace” will be a long slog underscores the difficulty they will have getting rid of the law and highlights how many of Trump’s more aggressive proposals will face hurdles in Congress. The potential for a years-long debate over a replacement for the law also indicates that Obamacare will continue to loom large over the political debate concerning the government’s role in health care.

It also goes against Trump’s recent assertion that moving from repealing to replacing the law will be a smooth, seamless endeavor.

“No, we’re going to do it simultaneously,” Trump said in a post-election interview on CBS’s “60 Minutes.” “It’ll be fine.”

But Hatch, who chairs the committee that oversees federal health-care programs, estimated it could take up to three years to disentangle all the programs that have been implemented. He dismissed concerns that voters would object to the delay.

“I don’t see any reason for anybody to be too upset about it,” Hatch said.

The prospect of a long, drawn-out fight over repeal has Democrats practically giddy about the chance to prove that Trump’s brash campaign promises will be difficult to achieve.

“I think they will be like the dog that caught the bus,” said Sen. Charles E. Schumer (D-N.Y.), the incoming Senate minority leader. “They’re stuck and that’s why they don’t have a solution.”

Schumer said Republicans have promised to keep “the good things” in the law, such as allowing children to stay on their parents’ plan until age 26 and banning insurers from using preexisting conditions to deny coverage, but haven’t released a plan for how they would replace the rest of the law.

House Majority Leader Kevin McCarthy (R-Calif.) dismissed concerns that a replacement plan is not ready.

“We’ve done a lot of work on this,” McCarthy said Tuesday at an event sponsored by The Washington Post.

He said Republican staff began preparing elements of a plan last year in anticipation of a Supreme Court ruling in the King v. Burwell case, which sought to overturn the law. The court ultimately upheld the Affordable Care Act, and Republicans were never forced to release their replacement plan.

McCarthy said Republicans would begin the replacement process by building off a basic outline that was included in the House GOP policy agenda released this year. That blueprint included plans to give states more sway over Medicaid through block grants and would replace government-operated insurance exchanges with voucherlike programs that would provide tax credits for individuals to buy health care from private insurers.

The House GOP vision is similar to legislation released by Rep. Tom Price (R-Ga.) who was tapped this week to be Trump’s nominee for secretary of the Department of Health and Human Services. His selection is a signal that Trump wants to move aggressively to get rid of the law and implement a new system.

The Price plan advocates the use of private health savings accounts that allow workers to set aside pretax money dedicated to health-care spending.

Republicans are planning to use a special tool in the budget process, known as reconciliation, that would allow them to avoid a filibuster and repeal Obamacare with a simple majority of 51 votes.

But the replacement legislation would not have that same protection as it moves through Congress.

This means that Republicans will have to work with Democrats to craft a bill that can pass the Senate with the votes of at least eight Democrats.

That will be a difficult challenge.

McCarthy said the filibuster will be a hurdle for any Obamacare replacement proposal. He also played down the chances that Congress could vote to repeal the law before Inauguration Day, an idea Trump once floated.

“I don’t think you can do it before [January] 20th,” McCarthy said. “There’s only so many legislative days we have.”