Republicans race to find ACA repeal compromise

President Donald Trump wants Congress to move quickly this week to dismantle the Affordable Care Act, but congressional Republicans are far from consensus on a repeal-and-replace effort that won’t leave millions of their constituents without insurance.

On Monday, two senators who have cautioned colleagues to delay repeal until they’ve settled on a replacement will unveil an alternative plan to give states the choice to retain Obamacare or be granted flexibility to expand Medicaid and other coverage options.

That alternative, from Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La, runs counter to the plans on the table, including one from Trump’s health secretary nominee Tom Price, known as the “Empowering Patients First Act,” which would offer tax credits, encourage the use of health savings accounts and urge states to develop high-risk pools.

“I’m not saying that it’s perfect, but it’s important that we put specific proposals on the table,” Collins said on the Senate floor about the plan she will advance this week. Repeal without replacement or repeal with a delay, as some lawmakers have suggested, would send insurance markets into a tailspin, she said.

In addition to Price’s plan, Republicans have considered House Speaker Paul Ryan’s 54-page “A Better Way” blueprint. Ryan’s plan would also offer tax credits to help people pay for insurance, and he wants to overhaul Medicare, which Trump has promised not to cut.

Complicating the situation, Trump’s pledge for “insurance for everybody” conflicts with what many fiscal-minded Republicans intend to do – and the yawning gap between congressional conservatives and their president on the issue is something Democrats are eager to exploit.

“I guess we have to wait for President Trump’s Twitter to figure out what the Republican plan is going to be,” said Rep. Ben Ray Luján, D-New Mexico, a member of Democratic leadership, which has sought to highlight Republican contortions over finding a solution. “They’re all on different pages and when they try to clean it up they contradict each other all over again.”

Trump made it clear in an executive action signed late Friday that he wants federal agencies to do what they can to stymie the law, which has brought health coverage to 20 million Americans.

Although the new Trump White House website does not list health care as one of the administration’s “top issues,” and it didn’t come up during his inaugural address, Trump addressed repeal in one of his first acts as president. He signed an executive order Friday that reiterates his administration’s intent to seek “the prompt repeal” of the 2010 law that has extended health care to 20 million Americans. But the executive order itself notes that regulations can be changed only through the traditional process of “notice and comment,” which can take months or even years.

And it will require his political appointees to be in office, which has yet to happen, particularly as Senate Democrats look to slow the nomination of Rep. Tom Price, R-Ga., Trump’s choice for Health and Human Services Secretary. Price, whom Democrats have accused of using his office to improperly buy health care stocks, goes before the Senate Finance Committee Tuesday for a confirmation hearing.

Trump has said his administration has a health care plan “very much formulated down to the final strokes.” But his promise a week ago of “insurance for everybody” has Republicans with an eye on fiscal restraint worried that he’s promising more than they can deliver. Vice President Mike Pence sought last week to clarify Trump’s words, telling CNN that Trump is talking about “making insurance affordable for everyone.”

Price also distanced himself from Trump’s pledge. He said at a Senate hearing that he was committed to seeing that Americans have “access” to health care coverage, which Democrats point out is not the same thing as guaranteeing coverage.

Indeed, Trump’s most recent pledge would suggest “a much more expansive plan than he even talked about on the campaign trail or than any of the proposals coming from Congress,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation. “We’re in a period of very little clarity.”

Many of the Republican plans would limit guaranteed insurance to people with continuous coverage and none of the Republican congressional plans have come up for a vote, nor have they been “scored” by the Congressional Budget Office, the nonpartisan office that provides Congress with economic and budgetary analysis, Levitt said.

“It’s hard to forge a consensus when you know legislation is going nowhere,” Levitt said of congressional Republicans who under former President Barack Obama would have seen health care packages vetoed. “They’ve had time, but very little incentive to make the tough trade offs that are required.”

Sen. Bob Corker, R-Tenn., who has been among a number of senators urging lawmaker not to uproot the law without offering an alternative, acknowledged the disarray, but said he expects Republicans to coalesce around a plan now that Trump has been sworn in and his team is moving to Washington.

“I don’t think there’s been much communication between the players,” Corker said. “They’ve been operating in New York partially, in Washington, partially. I’m hopeful that once they get here, we’ll get a little more synthesized about where we’re going to go.”

But that may not happen until Price is confirmed, which Corker acknowledged could take until mid-February: “You really haven’t had somebody yet laying out what needs to happen. Until then you’re probably going to hear a lot of mixed messages coming from people.”

Republicans in both chambers voted rapidly for a budget resolution that calls for a repeal plan to be delivered to the White House by Jan. 27, but that deadline is widely viewed as a moving target because of Republican qualms about moving too fast to overturn the law without an alternative.

“Before we take this plane in the air I want to know where we’re going to land it. Right now I’m not sure where we’re landing it,” said Rep. Charlie Dent, R-Pa., one of nine House Republicans who voted against the budget resolution.

There is a risk that a repeal and replace effort could pass the House, but “grind to a halt in the Senate,” Dent said. “That’s a concern, that we would repeal but not replace. That’s the question we all want to get answered: That if we do repeal and there’s no replacement, can we guarantee the protection of people.”

House Speaker Paul Ryan has promised a “full, exhausting” conversation on how Republicans will move forward on health care at this week’s congressional Republican retreat in Philadelphia. Trump and Pence are expected to attend the retreat that opens Wednesday.

“I believe we’ll be voting on a replacement plan that will be specific enough to start the debate,” said Rep. Mark Meadows, R-N.C., who has urged his party to develop a replacement plan before repeal. He said he expects “a real plan to replace it that has so much detail that we don’t leave those who are worried about in the lurch.”

Lesley Clark: 202-383-6054, @lesleyclark