GOP talk shifts from replacing ObamaCare to repairing it

Key Republican lawmakers are shifting their goal on ObamaCare from repealing and replacing the law to the more modest goal of repairing it.

It’s a striking change in rhetoric that speaks to the complexities Republicans face in getting rid of the Affordable Care Act. Many of the law’s provisions are popular, and some parts of the law that the GOP does want to repeal could have negative repercussions on the parts seen as working.

“I’m trying to be accurate on this that there are some of these provisions in the law that probably will stay, or we may modify them, but we’re going to fix things, we’re going to repair things,” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), a key player on healthcare, told reporters Tuesday.

“There are things we can build on and repair, there are things we can completely repeal,” he said.

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Senate Health Committee Chairman Lamar Alexander (R-Tenn.) is sounding a similar note. He notes that Republicans plan to use special budget rules known as reconciliation to prevent Democrats from filibustering a vote to repeal ObamaCare. The use of those rules won’t allow all of ObamaCare to be repealed.

“I think it is more accurate to say repair ObamaCare because, for example, in the reconciliation procedure that we have in the Senate, we can’t repeal all of ObamaCare,” Alexander said. “ObamaCare wasn’t passed by reconciliation, it can’t be repealed by reconciliation. So we can repair the individual market, which is a good place to start.”

Not everyone is on board with the new rhetoric.

Some Republicans say their party should be focused on repealing the law and replacing it, not repairing it.

“I’m hearing a lot of members say that they want ObamaCare-lite,” said Rep. Raúl Labrador (R-Idaho). “That’s not what we promised the American people.”

House Ways and Means Committee Chairman Kevin Brady (R-Texas) said he thinks the goal of fully repealing ObamaCare is still doable, while Senate Finance Committee Chairman Orrin Hatch (R-Utah) in a Wednesday speech to the U.S. Chamber of Commerce said “we need to repeal ObamaCare immediately” and then provide a transition to a new system.

The House is charging ahead with a plan to pass a bill under the fast-track process of reconciliation to repeal core elements of the law. Markups could come in House committees within the next couple of weeks, and leaders hope to have the bill on the House floor within a couple of months.

But that timeline could be pushed back.

Lawmakers have already started to face crowds of constituents concerned about what repeal might do to their own healthcare. Twenty million people gained health coverage under ObamaCare, and Republicans have promised that people will not lose their insurance because of repeal.

There is a split within Republicans over what to do about ObamaCare’s Medicaid expansion, which provided coverage to about 11 million new low-income people. Lawmakers from the 31 states that accepted the expansion are more likely to want to protect the expansion and the federal money for their states that came with it.

Other lawmakers are worried repeal could cause chaos in the insurance market that would be politically damaging to Republicans, or simply that their constituents could lose coverage under repeal. Some lawmakers also want to keep ObamaCare’s taxes in place to provide revenue for a replacement plan, while many others say repealing the taxes is a key part of repeal of the law overall.

Alexander made his comments after chairing a hearing Wednesday focused on targeted reforms to the insurance market to increase competition and allow for cheaper plans.

The Senate is taking a much slower pace than the House when it comes to ObamaCare — partly because of questions over how to handle the Medicaid expansion.

Sen. John Hoeven (R-N.D.), whose state accepted the expansion, said that he wants to keep it while providing more flexibility to states to make changes to the rules of the program, a common Republican goal.

“I think we should keep the Medicaid expansion, but we have to modify it to give the states more control so that they can manage it in a way that works in their state,” Hoeven said.

Even in the House, Walden acknowledged that some sort of compromise would have to be worked out around Medicaid expansion before Republicans would have enough votes to pass a repeal bill.

“It’s an issue in our conference because we have members whose states took it and members whose states didn’t; we want to be equitable about this,” Walden said. “We’re cognizant of this issue and fundamentally, if we don’t find the right sweet spot, we aren’t going to be able to pass it. I know how to count.”

Another thorny issue is whether to keep ObamaCare’s taxes. Some Republicans, like Sen. Bill Cassidy (R-La.), want to keep the taxes in place to provide revenue for a replacement.

But that appears to be a minority position. Hatch had some of the strongest comments yet on Wednesday, saying all the taxes “need to go,” despite calls by some to keep them.

Protections for people with pre-existing conditions and letting young people stay on their parents’ plans until age 26 are also areas Republicans commonly say they want to keep, though how to go about offering pre-existing condition protections is an open question.

Sen. Ron Johnson (R-Wis.) has gone so far as to explicitly reject the slogan of “repeal and replace.” He told CNBC last month that he wants to work with Democrats to “fix” ObamaCare.

“It’s way more complex than simply ‘repeal and replace,’ ” Johnson said. “That’s a fun little buzzword, but it’s just not accurate.”

—Jessie Hellmann and Cristina Marcos contributed.