GOP’s 3-bucket strategy to repeal and replace health law is springing leaks

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U.S. Vice President Mike Pence speaks about the American Health Care Act during a visit to the Harshaw-Trane Parts and Distribution Center in Louisville, Kentucky, on March 11, 2017. Photo by Bryan Woolston/Reuters

Republicans in Washington working to overhaul the Affordable Care Act say their strategy consists of “three buckets.” But it appears that all three may be leaking.

The plan to dismantle and replace Obamacare emerged after the Republican congressional retreat in late January. The first bucket is a fast-track budget bill that needs only a simple majority to pass the Senate. Because of congressional rules, however, it can only address parts of the health law that have immediate impact on federal spending.

The second consists of changes to regulations and other policies put in place by the Obama administration that could theoretically be undone by new Health and Human Services Secretary Tom Price. And the third is separate legislation that would do things Republicans have been advocating for many years, such as imposing caps on medical malpractice damages and selling health insurance across state lines.

All three are proving problematic at this point — among Republicans.

“There is no three-phase process, there is no three-step plan,” Sen. Tom Cotton (R-Ark.) told radio host Hugh Hewitt Tuesday. “That is just political talk. It’s just politicians engaging in spin.”

“Anyone who believes in the three-step process is believing in a fantasy,” said Rep. Raul Labrador (R-Idaho) at a press conference Thursday.

The first part, the so-called budget “reconciliation” bill, is already drawing fire within the GOP, not to mention among Democrats. Conservatives, like Sen. Rand Paul (R-Ky.), derisively refer to it as “Obamacare Lite” and oppose the bill’s tax credits to help people buy insurance as a new entitlement. Moderates have been shaken by the estimate from the Congressional Budget Office that 24 million people could lose their health coverage if the bill passes.

The bill has passed through several committees, but members of the conservative House Freedom Caucus say they might be able to stop the bill from passing the House, in spite of heavy pressure from Republican leaders and the Trump administration.

“The question is: ‘Am I OK losing my election because I did the thing I promised I would do?’” said Freedom Caucus co-founder Labrador, referring to his promise to repeal the entire law. He said the answer to that question is yes: “I can live with myself if I do the things I promised I would do.”

Complaints about the bill from a several Republican senators suggest that there are more than enough GOP “no” votes in that chamber to block its passage.

READ NEXT: How would the American Health Care Act affect cost and access?

Conservatives also question exactly how much of the law the administration can dismantle.

Price said at a CNN Town Hall Wednesday that he is ready to plunge into the “hundreds” of regulations and “thousands” of guidance letters issued by the Obama administration to implement the health law.

“If they hurt patients, they need to go away,” he said. “If they drive up costs, then they need to go away.”

But undoing all those rules comes with its own set of dangers.

“Step two requires us to believe that Tom Price is going to go outside the law,” Labrador said. He noted that conservatives often complain when an administration takes on authority not granted in legislation when devising rules.

“And we think the courts are not going to stop him from doing that?” Labrador asked. Reversing policy on existing law can open up new rules and regulations to lawsuits.

Cotton, in his radio interview, noted that whatever changes Price proposes are “going to be subject to court challenge, and therefore, perhaps the whims of the most liberal judge in America.”

Finally, while Republicans tend to agree on step three, the legislation that would implement their preferred policies for the nation’s health care system, there is one big hurdle: It would need 60 votes to pass a filibuster in the Senate, and getting eight Democrats to join seems highly unlikely.

“It’s not going to happen if you need 60 votes in the Senate,” said Sen. Lindsey Graham (R-S.C.) on MSNBC Wednesday.

Cotton agreed. “If we had those Democratic votes, we wouldn’t need three steps,” he said. “We would just be doing that right now on this legislation.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

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