House Speaker Paul Ryan (R-WI) arrives at his news conference after the House Republican meeting on Capitol Hill in D.C. P...

Can Republicans revive their effort to repeal Obamacare?

Last Friday, after failing to pass the House GOP’ health care bill, House Speaker Paul Ryan pronounced: “We’re going to be living with Obamacare for the foreseeable future.”

But the surprises keep coming. On Monday, just three days later, Ryan said: “If Obamacare just stays as is, that’s not acceptable to the American people.”

“That’s not what we said we would do,” he added. “So we’re going to figure out how we get this done.”

The 180-degree turn was the latest twist in the long-running fight over health care policy. It came after a rare Republican conference meeting Monday that excluded members’ staff. Usually that means choppy waters and angry words. (Before members could speak, Republican Rep. Ann Wagner of Missouri darted out and said, “the brawl has just begun.”)

But afterwards, members filed out all but holding hands, vowing to resurrect some kind of health care bill. Yet as the House GOP gears up for a possible Take Two, plenty of questions remain:

  • Are Republicans living in a fantasy world, or is another go possible? Do they know? This afternoon, Senate Leader Mitch McConnell (R-Ky) sounded like a man who had moved on. He said there were no plans in the Senate to visit the issue. “I want to thank the President and the Speaker, they went all out to pass a repeal and replacement. Sorry that didn’t work.”
  • When exactly will the GOP sort this out, if they do? Easter break begins in two weeks; it seems tax reform may fill the calendar for weeks, if not months, after that. In the meantime, health insurers must decide where they’ll offer coverage as well as their rates for next year by June.
  • Who will be key players in a future vote? The obvious place to look: the declared “no” votes from last week. (The New York Times had 33 on their list, while the Washington Post and The Hill each listed 36.)
  • How will President Donald Trump respond? As Republicans talked about a GOP bill, just last night their leader in the White House was tweeting about eventually working with Democrats. Is he lagging behind the mood on the Hill, or will he steer the debate in his own direction — toward minority leaders Nancy Pelosi and Chuck Schumer?

While we wait to see if congressional Republicans revive their health care bill, the debate over the nation’s health care system, and the state of the Affordable Care Act, is still raging. And there are plenty of ways the Trump administration, Congress and the health care industry can affect health care without a sweeping new law. Here are three additional things to watch as House Republicans mull reviving their repeal effort.

  1. Insurers. Insurance companies have until June to give the government their bids for which state and federal exchanges they will enter and how much they will charge in premiums. They face one potential unknown: How stridently will the IRS under the Trump administration enforce the individual mandate penalty? The answer could determine how many younger, healthier people join the exchanges, which in turn will determines whether insurers enter more markets and offer lower premiums.
  2. Congress. Republicans have one closely-watched decision ahead apart from their larger repeal effort. They must decide whether to move forward with a lawsuit filed during the Obama administration which challenges a particular set of subsidies in the Affordable Care Act: those that help people with cost-sharing, i.e. deductibles and out-of-pocket costs. Insurers fear that without those subsidies, some Americans on their plans will not pay significant portions of their bills. The court is looking for an update on the case from Republicans by May 22.
  3. HHS Secretary Tom Price. The Affordable Care Act is packed with “the secretary shall” responsibilities that Price oversees directly as the head of the Department of Health and Human Services. Those include specifying precisely what fits into each category of essential benefits and deciding whether to waive some Medicaid requirements for states. At the same time, insurers are hoping Price moves forward with several rules to stabilize the markets, including lining up enrollment windows so the timeframe for Medicaid and employer enrollment periods coincide more closely.