GOP sweep puts ObamaCare in jeopardy

The GOP’s shocking wave victory in Tuesday’s elections has put ObamaCare in jeopardy, as Republicans vow to go after the law. 

Donald Trump’s once-implausible presidency has created the first opening in six years for Republicans to take aim at the healthcare law as they seek to dismantle President Obama’s signature domestic policy.

{mosads}Trump has vowed to repeal ObamaCare as one of his first acts in office.

His resounding electoral victory comes with intense pressure for GOP leaders, who maintained their majorities in the House and Senate, to make good on their longtime promise to fully repeal the law.

The Republican sweep places a huge cloud of uncertainty over the 20 million people who gained healthcare coverage under ObamaCare. It will also shake up the healthcare industry, which has spent years adapting to the law and is certain to fight repeal efforts.

Senate Majority Leader Mitch McConnell (R-Ky.) said Wednesday he would be “shocked” if Republicans did not move forward with repealing the law, saying the “sooner we can go in a different direction, the better.”

Speaker Paul Ryan (R-Wis.) said before the elections that Republicans planned to use a special procedure called reconciliation that would allow a repeal bill to get through the Senate with a simple majority, rather than the usual 60 votes. He said last week it is an “action plan,” not a “vague promise.”

That process, which Republicans tested last year, would take away core elements of the law, such as Medicaid expansion and subsidies to help people buy coverage, while leaving some parts in place. Leaving a half-formed law in place could cause even more disruption to insurance markets.

Ryan again mentioned the reconciliation process that Republicans tested out last year when asked Wednesday about repealing ObamaCare.

“This House majority, this Senate majority, has already demonstrated and proven we’re able to pass that legislation and put it on the president’s desk,” Ryan said at a post-election press conference. “The problem is President Obama vetoed it. Now we have President Trump coming, who is asking us to do this. So with unified Republican government, we can fix this. We can fix these problems.”  

McConnell on Wednesday declined to discuss if reconciliation would be used. 

The GOP’s toughest challenge ahead, though, involves replacing ObamaCare — a problem that has consistently dogged Republicans since the law’s passage.

Experts say it is likely a repeal bill would have a delayed date on which to take effect, giving lawmakers time to conceive a replacement plan. 

The reconciliation bill last year did not include a replacement, but instead phased out the subsidies and Medicaid expansion over two years.

Republicans would face difficulty uniting around the details of a plan and dealing with factors such as cost estimates, despite the outline put forward by House Republicans this year.

Joe Antos, a healthcare expert at the conservative American Enterprise Institute, said there would have to be some kind of transition period so people are not kicked off their plans right away. 

“I don’t think you can get anybody to say, ‘OK, on Feb. 1 you’re off,’ ” Antos said. 

“2018 is another matter,” he added, though he noted that the law could be adapted rather than completely scrapped. 

In an interview, Sen. John Barrasso (R-Wyo.) would not absolutely commit to using reconciliation to repeal ObamaCare, saying the GOP still needs to meet with the Trump transition team. But he spoke favorably of the test run the process got last year. 

He noted that Vice President-elect Mike Pence has called for a transition period so ObamaCare enrollees do not lose their coverage right away. 

What would come as a replacement at the end of that transition period is unclear, though. 

“You can repeal the whole law with reconciliation, but we need to make sure, and Mike Pence said this in his speech last week — he said that there’s going to have to be a transition for the people who are on ObamaCare,” Barrasso said. 

He said that a shorter-term step would be to pass bills giving people relief from ObamaCare’s mandate to buy insurance, like a measure from Sen. John McCain (R-Ariz.) to exempt people from the mandate if they have only one insurer, or none at all, to choose from in the law’s marketplace.  

The politics of ObamaCare could be trickier for Republicans now that they are in power and can enact repeal, though. 

Chris Jacobs, a former Republican congressional staffer and policy analyst, noted on Twitter that some Republicans might hesitate to vote for repeal now that it can actually be signed into law if there is no replacement readily available.

“Some GOP lawmakers who voted for the ‘theoretical’ repeal bill might fear doing so for real,” he wrote. “The old ‘Vote No, Hope Yes’ theory.”

Some Republicans say they hope Democrats might join them in making changes to the law, perhaps making reconciliation unnecessary. But it would be a steep climb for members of President Obama’s party to agree to changes sweeping enough to satisfy Republicans. 

“Let’s see if we can reach some sort of consensus with our Democrat friends to make this repeal and replace [work],” Sen. Roger Wicker (R-Miss.) told reporters Wednesday. 

As for what he would say to the 20 million current ObamaCare enrollees with concerns about losing their coverage, Barrasso argued that coverage is often inadequate because of high deductibles. 

“What do you say to the people who have been writing about the fact that they have coverage but they can’t get care, because the deductibles are so high?” he said. “The question is about getting people care, not the president’s empty words of coverage.”

Alexander Bolton contributed. 

Updated 4:38 p.m