Two top Republicans long expected to lead the Senate’s role in repealing the Affordable Care Act said publicly this week that they are open to repairing former president Barack Obama’s landmark health-care law ahead of a wholesale repeal, which has been a GOP target for eight years.
Coming one week after a closed-door strategy session in which Republicans expressed frank concerns about the political ramifications of repealing the law and the practical difficulties of doing so, statements this week by Sen. Orrin G. Hatch (R-Utah) and Sen. Lamar Alexander (R-Tenn.) brought into public view the political and policy challenges the GOP is facing.
Alexander, chairman of the Senate Committee on Health, Education, Labor and Pensions, said at a hearing Wednesday: “I think of it as a collapsing bridge. . . . You send in a rescue team and you go to work to repair it so that nobody else is hurt by it and you start to build a new bridge, and only when that new bridge is complete, people can drive safely across it, do you close the old bridge. When it’s complete, we can close the old bridge, but in the meantime, we repair it. No one is talking about repealing anything until there is a concrete practical alternative to offer Americans in its place.”
And Hatch, chairman of the Senate Finance Committee — another panel with a crucial role in the effort to repeal the ACA — said Thursday that he “could stand either” repealing or repairing the law. “I’m saying I’m open to anything. Anything that will improve the system, I’m for,” he said.
The comments come one month after Republicans in Congress first set out to immediately repeal and replace the Affordable Care Act. While an increasing number of them have expressed concern about how feasible it is, many others, including House Speaker Paul D. Ryan (R-Wis.), remain committed to a wholesale repeal and replacement.
On Thursday, Ryan tried to right the party’s message on health care by insisting that repair is the same thing as replace.
“There’s a miscommunication going on,” he said Thursday morning on “Fox & Friends.” “If we’re going to repair the U.S. health-care system . . . you must repeal and replace Obamacare.”
Although Alexander has advocated a go-slow approach for weeks, Hatch has aggressively pushed to repeal the ACA, including the tax provisions that help most people with health plans under the law afford their premiums.
His comments Thursday seemed to contradict a statement the day before, when he told an audience at the U.S. Chamber of Commerce that he wanted to quickly repeal as much of the law as possible.
“I believe that we need to repeal Obamacare immediately, and provide for a stable transition period,” Hatch said. “In my view, we need to advance replacement policies in tandem with the repeal process. And then we can keep working on the other parts of the system.”
Yet Hatch has also consistently warned conservatives that there are limitations to what Congress can do to unwind the law. The Senate has chosen to use a special budget process to walk back as many provisions as possible, but they will be limited to tackling the parts of the ACA that deal with spending, taxes and the deficit.
Concerns over those limitations have created frustration and consternation within the GOP, as was clear on a recording obtained last week by The Washington Post and other news outlets.
On the recording, made last week at a GOP retreat in Philadelphia, a number of Republicans worried that they would be blamed if the health-care system implodes in the wake of their repeal plans.
Among those most concerned was Alexander, who said: “The word ‘repair’ is a lot better than the word ‘repeal.’ . . . Saying we’re going to repair the damage is more accurate.”
Other Republicans in the House and Senate besides Ryan have tried to regain control of the message in recent days by saying that repair is just another way to explain their replacement plans. What’s less clear is whether concrete plans are underway to dismantle the law.
Sen. John Cornyn (R-Tex.), the No. 2 Republican leader, said Thursday that the procedural process in the Senate and the words used to describe it can be complicated but goal is still the same: getting rid as much of the Affordable Care Act as they can.
“It gets a little confusing,” Cornyn said. “I don’t think even if we wanted to repair Obamacare we could do it. That’s why I believe we’re going to do repeal and replace.”
In the House, the messaging has been no less complicated. While the word “repair” has held appeal for moderates who are wary of repealing Obamacare root and branch, it has raised alarms among fervent conservatives who see in it a potential betrayal of their campaign promises.
“If you’re talking about repairing the Affordable Care Act, it’s unrepairable,” said Rep. Mark Meadows (R-N.C.), chairman of the hard-right House Freedom Caucus. “We need to repeal it. We need to replace it. If you want to call that a repair, so be it, but I don’t know that that makes it any more palatable to the folks back home.”
Ryan later told reporters on Capitol Hill, “Our job is to repair the American health-care system and rescue it from the collapse that it’s in. And the best way to repair a health-care system is to repeal and replace Obamacare. It’s not an either/or.”
Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee and a key architect of GOP health-care plans, has favored yet another R-word in recent days: “rebuild.”
“Working with the Trump administration, we’ll take a multi-step, multi-pronged approach to deliver relief and rebuild our health care system so it works for patients,” he wrote with fellow committee member Rep. Michael C. Burgess (R-Tex.) in an op-ed published by Morning Consult on Tuesday.
Meanwhile, the Trump administration is working on its initial changes in federal rules under an executive order the president signed his first night in office to ease the ACA’s regulatory impact on consumers and segments of the health-care industry.
The possible rule changes, under review by the Office of Management and Budget, would be aimed at helping health insurers keep the law’s marketplaces functioning while Congress and the White House try to design new health policies.
According to Edmund Haislmaier, a senior fellow at the Heritage Foundation and member of the Trump transition team for the Department of Health and Human Services, the proposed rules being considered could further restrict Americans’ ability to sign up for ACA health plans outside of the annual open-enrollment season.
They also could require more extensive checks of applicants’ eligibility for marketplace coverage and prohibit consumers from enrolling in health plans for another year if they are behind on their premium payments.
Amy Goldstein contributed to this report.