Washington: Congressional Republicans, meeting behind closed doors this week in Philadelphia, expressed grave concerns about dismantling the Affordable Care Act on the urgent timetable demanded by President Donald Trump, fretting that, among other things, they could wreck insurance markets and be saddled with a politically disastrous “Trumpcare.”
An audio recording of a session at their annual retreat, obtained by The New York Times, shows Republicans in disarray, far from agreement on health policy, and still searching for something to replace former President Barack Obama’s health care law. While their leaders called for swift action to rescue consumers from the Affordable Care Act, some backbench Republicans worried about potential pitfalls.
“We had better be sure that we are prepared to live with the market being created,” said Rep. Tom McClintock of California, because “that’s going to be called Trumpcare.”
He added, “Republicans will own it lock, stock and barrel, and we’ll be judged on that.”
When Democrats were writing the Affordable Care Act seven years ago, their primary goal was to provide health insurance to more people, an ambition that the Obama administration went to great lengths to fulfil as it enrolled millions of people in Medicaid or private health plans.
Now, as Republicans try to devise a replacement for the law, they have set a nearly impossible standard for themselves: They have promised that none of the 20 million people who gained coverage through the Affordable Care Act will lose it if the law is repealed, even as they lift its mandates and penalties, pull back the tax increases that pay for it and pledge to enact a new program that will be cheaper for taxpayers and consumers.
In their private session, the recording of which was first reported on by The Washington Post, Republicans revealed that they understood the predicament they had largely created for themselves.
“I recognise that we can’t keep Obama’s promises,” Rep. Tom MacArthur of New Jersey said. “They were wrong to begin with, and the system can’t be sustained.” He worried aloud about the possibility that some people could lose insurance as the law is unwound.
“We’re telling those people that we’re not going to pull the rug out from under them, and if we do this too fast, we are, in fact, going to pull the rug out from under them,” MacArthur said. After giving states the choice to expand Medicaid under the law, he said, reversing that expansion too quickly would run the risk of pulling a “bait and switch with the states.”
The lawmakers’ concerns contrasted with the confidence that Republican leaders and Trump have expressed as they rush to replace Obama’s signature domestic achievement, also known as Obamacare. Congress this month approved a budget blueprint that clears the way for quick action to repeal major provisions of the law, and Trump has said Congress should repeal and replace the law at the same time, putting pressure on lawmakers to agree on an alternative.
That budget measure created an aspirational deadline to draft repeal legislation by January 27, a day that came and went.
Privately, Republicans made clear they understand the risks they are running. At their session this week, they voiced concern that their efforts to undo the law could have harmful consequences, such as inadvertently destabilising insurance markets — a concern shared by Democrats and insurers.
Under Senate rules, the Senate could vote to repeal major provisions of the Affordable Care Act using fast-track procedures that neutralise the threat of a Democratic filibuster. “We can repeal parts of it,” McClintock said, “and the parts that remain, I’m concerned, could make the market even more dysfunctional.”
Republican leaders tried to reassure anxious backbenchers, making the same points in private as they have in public.
“We don’t own Obamacare,” said Sen. John Barrasso of Wyoming, chairman of the Senate Republican Policy Committee, adding: “We are the rescue party. We campaigned to provide relief and help repair the damage.”
Republican leaders have predicted that Democrats will come to the table to help draft a replacement once it becomes clear that the health law will be repealed. But some rank-and-file members were not so sure.
Rep. John Katko of New York wondered what Republicans would do “if we can’t get anything out of the Democrats.”
Another New York Republican, Rep. John J. Faso, warned colleagues they were playing with fire if they cut off funds for Planned Parenthood clinics, as Speaker Paul Ryan has said Republicans intend to do.
“Health insurance is going to be tough enough for us to deal with, without allowing millions of people on social media to come to Planned Parenthood’s defence,” Faso said. He wanted to know from the administration that “we’re not going to have a tweet from the president” saying “we should protect Planned Parenthood.”
“We’re making a grave mistake including this Planned Parenthood provision in a health care bill,” he said.
Chris Jacobs, a health policy analyst who previously worked for Republicans in Congress, said Republicans and Trump were at risk of overpromising, just as Obama did.
“Conservatives should not remain fixated on the number of people with health insurance when designing an Obamacare alternative,” Jacobs said. “We will never win the battle with liberals if you measure success in terms of how many people have health insurance cards. We don’t want to spend as much as liberals, and we don’t believe in coercing people to buy insurance.”
Democrats remember how Republicans hounded Obama for breaking his promise that “if you like your health care plan, you can keep your health care plan.” Democrats say they will hold congressional Republicans and the Trump administration accountable in the same way.
