President Donald Trump wants Congress to repeal Obamacare now and worry about replacing it later. But that’s a non-starter for many congressional Republicans who don’t want to scrap a plan that’s covering millions of Americans without something to take its place.
Repealing the health law without a replacement would kick about 18 million Americans off of health coverage in the first year — and reach 26 million a few years later, according to a CBO analysis of a 2015 bill to repeal the health law without a replacement. About 20 million people are covered now under the Obamacare markets or the law’s Medicaid expansion. Repealing the entire law would remove subsidies, cut coverage, take away protections for pre-existing conditions and send premiums skyrocketing.
Coming up with the replacement has been far more difficult than lawmakers, or Trump, imagined. Senators left Washington Thursday for a week-long July Fourth recess having failed to get 50 votes to repeal and replace Obamacare in time for the late June vote GOP leaders had sought. Their new goal is to pass a bill in July, perilously close to the long August recess.
Some Republicans are growing impatient — including the president. Republicans have promised for years to repeal Obamacare and the conservative base wants them to get on with it.
"If Republican Senators are unable to pass what they are working on now," Trump tweeted Friday morning, "they should immediately REPEAL, and then REPLACE at a later date!" The president has given a lot of mixed signals about Obamacare repeal, at one point calling the House version "mean" and expressing doubt about whether Congress would pass repeal.
Immediate repeal could create chaos in the insurance markets. That would violate the pledge some Republicans, including Trump, have made that people would not lose their health coverage under a GOP health plan.
Trump’s tweet comes after Sen. Ben Sasse (R-Neb.) asked Trump to call for swift action. In a letter to the president, Sasse suggested Trump should call for immediate repeal and then cancel the August recess to get replacement together. Republicans, who had promised a quick repeal vote in January, have instead taken months and their internal divisions are still far from resolved.
"On the current path, it looks like Republicans will either fail to pass any meaningful bill at all, or will instead pass a bill that attempts to prop up much of the crumbling ObamaCare structures," Sasse wrote. "We can and must do better than either of these – both because the American people deserve better, and because we promised better."
Conservatives such as Sasse and Sen. Rand Paul (R-Ky.) argue that the Senate bill keeps too much of Obamacare in place.
Paul praised Trump’s idea. "I have spoken to @realDonaldTrump & Senate leadership about this and agree. Let’s keep our word to repeal then work on replacing right away," he said in a tweet.
When Republicans took control of Washington in January, they planned on using a fast-track procedure for repeal and not allow a Democratic filibuster to slow them down. The plan was to follow that up with replacement legislation under regular order. But that would mean they would need support from at least eight Democratic senators.
That plan was quickly tossed because many rank-and-file Republicans — particularly moderates — were nervous about eliminating benefits without offering a replacement. They reasoned that Democrats would never come to the table and their voters would be left without health care coverage.
In recent weeks, many moderate Republicans have been further emboldened with concerns about people losing coverage, given that the Congressional Budget Office has forecast 22 to 23 million more people would be uninsured in a decade. In the Senate, moderates are pushing Majority Leader Mitch McConnell to strengthen the financial assistance for low-income people, even if it means giving up some tax cuts.