WHY OBAMACARE IS UNLIKELY TO DIE A SWIFT DEATH

[1/3/17]  Congressional Republicans have long boasted that once they claim the reins of power, they will act quickly and decisively to roll back what they view as the most onerous piece of President Obama’s domestic agenda: the Affordable Care Act.

But their actions starting Tuesday to end Obamacare will be far less sweeping, at least initially, than a full-blown repeal of the law.

Democratic opposition and complex Senate rules mean that core pieces of the 2010 health-care overhaul are likely to remain, including the legal framework for the individual mandate and pieces of the state exchanges the law created. Furthermore, President-elect Donald Trump has vowed to preserve other key aspects, such as a ban on insurers denying coverage because of preexisting conditions and a requirement that insurers cover children under 26 on their parents’ plans.

And while Republicans are determined to rapidly repeal as much of Obamacare as they can, they have not settled on a replacement plan or on when that plan should take effect.

“We will move right after the first of the year on an Obamacare replacement resolution,” Senate Majority Leader Mitch McConnell (R-Ky.) said during a December news conference. “Then we will work expeditiously to come up with a better proposal than current law, because current law is simply unacceptable and not sustainable.”

According to the latest estimates from the Department of Health and Human Services, the resulting jumble is likely to have an unpredictable and messy effect on the insurance marketplace, jeopardizing the health coverage of the 20 million people who have gained it under the Affordable Care Act.

The rush to immediately chip away at Obama’s regulatory and domestic policies through the complex process known as budget reconciliation could create months of messy GOP infighting. The plan to vote now on repeal and work out the details later means Republican leaders will be slogging through the difficult process of writing a health-care replacement while simultaneously trying to scale back regulations in areas such as clean air and immigration, and possibly tackling a tax-code overhaul. It will be the first real test of how effective the GOP-controlled Congress will be.

A wild-card element is where Trump stands on the details of replacing the ACA — he has said more about the pieces he would like to keep than his ideas for remaking it. Trump’s stance may be clarified after Vice President-elect Mike Pence — a leader in the Obamacare repeal effort during his time in Congress — joins House Republicans to discuss the ACA on Wednesday at their first weekly gathering of the year.

Democrats warn that a frenzied push to dismantle Obama’s legacy could leave Republicans without any hope of getting the bipartisan support necessary to push through other parts of the Trump agenda, including the replacement bill and a pricey infrastructure project.

House Minority Leader Nancy Pelosi (D-Calif.) suggested in a conference call Monday afternoon that the reason Republicans are not moving immediately to replace the health-care law is because they can’t. “The reason they can’t make a proposal is because they don’t have the votes,” Pelosi argued.

The budget legislation containing repeal — which leaders plan to introduce in the Senate as early as Tuesday — will be a bare-bones outline of GOP spending priorities. It will also include very general instructions for committees in the House and Senate to write the actual bills repealing the law. The budget resolution can be passed by a simple majority, but McConnell is required to allow lawmakers to offer a nearly unlimited number of amendments in a process, known as a “vote-a-rama,” that could take up to a week to complete.


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