President Donald Trump’s election gave Republicans something they had wanted for years. At long last, they seemingly had the system in place to keep one of their longest standing political promises: repealing and replacing Obamacare.
The Affordable Care Act, the massive healthcare bill from President Barack Obama, had been a target for Republican leaders like House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell since before the bill was even signed into law.
But a month into Trump’s presidency and controlling both branches of Congress, Republicans are finding that repeal and replace is easier said than done. From disagreements over the future of the healthcare system to unclear communication, cracks are beginning to form in the overhaul. And people are starting to get restless.
“The House passed six Obamacare repeals when Obama was president and there was no chance of them being signed into law,” conservative author Ann Coulter wrote in a post on her blog. “Back then, Republicans were full of vim and vigor! But the moment Trump became president, the repeals came to a screeching halt.”
Her post was titled, “The Silence of the Lambs Congress.”
‘Were we just against Obamacare because it was proposed by the Democrats?’
Serious ideological differences have emerged within the party regarding exactly what the future of healthcare should look like.
More moderate Republicans have considered keeping certain aspects of Obamacare that have become well-liked among their constituents — and, more broadly, with the American public in general. Recent polls have shown Obamacare has more support than opposition for the first time in the law’s history, and in some of the surveys, positive opinion of the law is at an all-time high.
One of the more popular aspects of the law has been the expansion of Medicaid coverage for poorer Americans. The expansion was primarily funded by the federal government and optional for states, though 32 and the District of Columbia have taken up the offer.
Republican senators and governors in states that have expanded Medicaid have called for the new replacement bill to include funding for Medicaid expansion rather than rolling it back. The expansion has been shown to bring down the costs of coverage in the individual market and has helped improve the uninsured rates in states that have expanded.
On the other end of the spectrum, however, more conservative members of the party want a more radical approach to healthcare reform, permanently pulling back large parts of the ACA’s provisions.
Sen. Rand Paul reportedly walked out of a meeting of Republican lawmakers on Tuesday because he felt the discussion was turning toward preserving parts of Obamacare.
“I hear things that are unacceptable to me,” Paul told Politico afterward. “If they don’t seem to care what conservatives think about complete repeal of Obamacare, they’re going to be shocked when they count the votes.”
Though some Republican leaders denied those issues were on the table, it was clear that Paul — who introduced his own version of a repeal-and-replace bill a few weeks ago — did not find the alternatives being discussed palatable.
On the House side, the House Freedom Caucus — made up of some of the more conservative members of the party — voted this week to not back a repeal of Obamacare unless it went as far as a 2015 repeal bill that was vetoed by Obama. That legislation repealed as much of the law as possible.
The House Freedom Caucus, much like Paul, is against the expansion of Medicaid and wants to cut off the funding for that program.
One of their members, Rep. Raúl Labrador, laid out the frustration on Wednesday, decrying the lack of changes being proposed by more moderate GOP members.
“Something that Republicans need to be concerned about is that if we’re just going to replace Obamacare with Obamacare-lite, begs the question, were we just against Obamacare because it was proposed by the Democrats?” Labrador said. “And if that’s our position then we’re very hypocritical. Then we really were just taking a political positions, not a policy-based position.”
Even in the administration, two countervailing ideas have emerged.
On the one hand, the Trump administration’s moves since taking office have attempted to undermine the law. The Department of Health and Human Services scaled back their efforts to enroll people for Obamacare plans during the last two weeks of the open-enrollment period in January, leading to a decrease in enrollment for the year.
Additionally, new rules proposed by the administration this week would cut the open-enrollment period in half and weaken the minimum standards of care to qualify for various plan levels on the exchanges.
On the other hand, the same rules took up some suggestions from the Obama administration in strengthening special enrollment periods and helping to balance risk pools.
Mixed messages
The GOP divergence on Obamacare has shown up not only in policy preferences, but also in how Republicans talk about the law.
For one thing, it is hard to get a grasp on just how long the process of repeal and replace is supposed to take.
While Ryan has said he hopes to complete the Obamacare replacement process by the end of the year’s first quarter, he has also said in interviews that it could be the end of the summer or the end of the year. (A Ryan spokesperson said in an email to Business Insider that the speaker plans to complete the process by March.)
Ryan said Thursday that the House GOP was planning to roll out a bill on Obamacare when the body comes back from its week-long Presidents Day break.
Senate Majority Leader Mitch McConnell has been less definitive about a timeline. He said only Friday that repeal and replacement of the law would happen “when we get the votes.”
Trump hasn’t made the communication any clearer. In an interview on January 10, Trump said he wanted the replacement done “next week.” In an interview with Bill O’Reilly on February 6, however, the president it could take into 2018 to get the replacement done. (Ryan has said Trump was referring to implementation, not legislation.)
Outside of leadership, the messages are just as muddled. On the one end, the House Freedom Caucus wants a repeal as soon as possible, while some Republican lawmakers are inclined to wait until a full replacement bill is vetted and ready to go.
On the policy communication side, the differences between the moderate and conservative parts of the Republican party are also starting to show.
Many Republicans have begun to soften the way they are talking about the repeal and replace, instead referring to the endeavor as a “repair.”
Growing dissatisfaction
Amid the dysfunction, a growing chorus of conservative commentators are becoming impatient with the slow progress of reform.
Conservative commentators from Fox News’ Sean Hannity to internet mogul Matt Drudge to Coulter have all expressed displeasure with the slow pace of replacement.
Last week, Hannity aimed an extended tirade at congressional Republicans, charging that they have failed to so far “abolish Obamacare” and pass many other of their policy proposals.
“These spineless, gutless, timid politicians have all three,” Hannity said. “They have the House, the Senate, and the White House. What’s their excuse now?”
Ryan appeared on Hannity’s show Thursday night, where he laid out his March timeline for the Fox News commentator. It seemed to encourage the host.
“When I heard ‘repair,’ my head nearly exploded,” Hannity told Ryan.
“That’s not the plan. The plan … repeal and replace this law, like we said,” Ryan responded. “We ran on a plan to repeal and replace it. Tom Price helped write that plan. He is now Donald Trump’s secretary of HHS.”
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Coulter also took the GOP to task for their insistence on repealing the law when Obama was in office, but doing nothing since Trump became president.
“What was in the last six Obamacare repeals? If we looked, would we find, ‘All work and no play makes Jack a dull boy’ carefully typed out 1 million times? Seriously, what does Paul Ryan’s day look like?” she wrote.
And Drudge, who runs the influential conservative website the Drudge Report, took a shot at the delay of Obamacare’s repeal.
“No Obamacare repeal, tax cuts! But Republicans vote to shut Warren?” Drudge tweeted with a link to an article about Republicans voting to silence Democratic Sen. Elizabeth Warren, later adding the lack of movement on this and other policies means the Republican party should be “sued for fraud.”
Even conservative groups are getting impatient. Heritage Action spokesperson Dan Holler told the New York Times that the delay is worrying.
“If the House has not passed a repeal bill and sent it to the Senate by mid-March, that would be serious cause for concern,” Holler said.
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