By Kelsey Snell, Mike Debonis, Washington Post–
House Speaker Paul D. Ryan (R-Wis.) spent Tuesday on a door-to-door tour of the Capitol in hopes of salvaging his plan to repeal and largely replace the Affordable Care Act by spring.
The day-long blitz comes as Republicans in Congress have made virtually no visible progress in recent weeks on overhauling the health-care system, according to interviews with several senior GOP aides.
That is largely because the party remains sharply divided over how much of the ACA should be repealed and how much — if any of it — should be replaced. The stalemate has lawmakers questioning whether the law known as Obamacare can be effectively gutted by Ryan’s self-imposed deadline of the end of March.
“I don’t think you can fully repeal and replace it in that amount of time,” said Rep. Tom Cole (R-Okla.). “It took months to write Obamacare, the original bill, and years to phase it in. It is going to take time to unwrite it and replace it with something else.”
Ryan’s efforts are being stymied by a host of factors, including a familiar revolt from his most conservative members, who want to keep their promises to eliminate Obamacare regardless of the pace of a replacement measure. Meanwhile, Senate Republicans are not ready to act on any kind of repeal without a consensus replacement plan. The Washington infighting is playing out against a backdrop of rowdy GOP town halls across the country showcasing people worried about the impact on their lives of potentially losing their health insurance.
For Ryan, the stakes could not be higher. While trying to satisfy his right flank, the speaker also must consider the potentially explosive impact of the health-care debate on his quest to maintain and grow the GOP majority in the 2018 midterm elections. Further confusing things is President Trump, who has both vowed to repeal and replace the ACA immediately, and said that such a process would take until 2018.
Dozens of GOP members attended an afternoon briefing Tuesday on Medicaid. The issue is one of the biggest sticking points among Republicans, opening divides between lawmakers in states who have accepted the program’s expansion under Obamacare and those who have opted out, forgoing hundreds of millions of federal dollars a year in protest against the law.
Inside the closed-door sessions, senior lawmakers walked through a variety of options for replacement — including a radical reorientation of the Medicaid program, an open-ended insurance entitlement and a fixed “block grant” that would let states decide how to apportion health-care dollars for the needy. They also considered an indefinite extension of the ACA Medicaid expansion that would allow those now covered to remain so.
“They got to see a lot of the details of the plans that we’re working on,” said House Majority Whip Steve Scalise (R-La.), who hosted the session. He added, “There’s a lot of work left to be done.”
Republican senators who represent states that expanded Medicaid — including Bill Cassidy (La.), Rob Portman (Ohio) and Lisa Murkowski (Alaska) — huddled last week to discuss concerns that a House GOP repeal bill could leave millions of their constituents without insurance. While no consensus emerged, many lawmakers said they could not support an aggressive repeal bill that could harm so many of their constituents.
“We’ve added 27,000-some-odd Alaskans to the covered rolls,” Murkowski said Tuesday. “I want to make sure whatever we do post-ACA, we don’t leave these good folks hanging.”
The debate is playing out against a backdrop in which the proportion of Americans without health insurance through most of last year remained at the same low level as in 2015, according to survey data released Tuesday by the National Center for Health Statistics. The data, covering January through September 2016, showed that 8.8 percent of people of all ages were uninsured compared to the 9.1 percent uninsured through 2015, according to the U.S. Census’s most recent annual report on health insurance rates.
It is unclear how much of that improvement is the result of an improving economy and how much was brought about by the ACA’s impact. Meanwhile, the insurer Humana announced it would stop selling individual plans under the ACA after this year.
On Capitol Hill, Republicans are locked in a battle for control over the repeal process. Conservatives are seeking to reassert their influence after several weeks where more-moderate lawmakers — and Trump himself — have seemingly argued for a more deliberate process.
Members of the hard-right House Freedom Caucus and conservative Republican Study Committee are insisting that a repeal bill should go at least as far as a measure they approved in 2015. That bill ended with a veto from President Obama, but GOP leaders touted it as a test run for what could be possible with a Republican president
“What we’re trying to do is really create some urgency,” said Rep. Mark Walker (R-N.C.), chairman of the Republican Study Committee. “We’re okay with talking through that and hearing what they