Senate Budget Chairman Mike Enzi, R-Wyo., on Tuesday unveiled his vehicle for repealing Obamacare and aims for the Senate to pass it next week.
That's the plan anyway. Repealing President Obama's signature legislative accomplishment is the GOP's top priority following the party's congressional and White House sweep on Nov. 9. Enzi has employed some legislative engineering to make sure the leadership's desire to repeal Obamacare and replace it with something else complies with Senate rules forbidding budget reconciliation bills that increase the deficit. The plan he will introduce this week will be included in the 2017 budget reconciliation bill and sets aside a lot of the savings from repeal to pay for a GOP health coverage plan that would come later.
"Today, we take the first steps to repair the nation's broken health care system, removing Washington from the equation and putting control back where it belongs: with patients, their families, and their doctors," Enzi, R-Wyo., said in a statement.
"This is the first step toward relief for Americans struggling under Obamacare. This resolution sets the stage for repeal followed by a stable transition to a better health care system," said House Speaker Paul Ryan of Wisconsin. "Our goal is to ensure that patients will be in control of their health care and have greater access to quality, affordable coverage."
Voting on the bill and the amendments senators offer in the Senate would begin this week and continue into next week. Enzi and the rest of the GOP leadership aim to send the bill to House for an up or down vote without any amendments allowed.
But Enzi and other Capitol Hill leaders will have to contend with a caucus split over how best to do away with Obamacare without alienating more than 20 million Americans who depend on the law for healthcare coverage. They also must contend with Democrats determined to fight Republicans at every step of the repeal process. Enzi will need to corral support from some combination of these fractious players.
Democrats, of course, oppose the whole plan and intend to draw out the vote by demanding consideration of amendment after amendment in the Senate.
"The ACA extended health care to 30 million Americans," New York's Chuck Schumer said during his first speech as Senate Minority Leader. "We ask the president-elect: If you repeal the ACA what are you going to do to protect these 30 million people? It is not acceptable to repeal the law, throw our health care system into chaos and then leave the hard work for another day," he said.
Various Republicans pose a big threat for gumming things up too. Some members of the Freedom Caucus, the most adamant supporters of a quick repeal want all the budget savings generated by repealing Obamacare to be used for deficit reduction and want to eliminate savings set-asides that would be used for a replacement to the law.
One-time GOP presidential candidate Sen. Rand Paul of Kentucky is urging Congress to repeal and replace ObamaCare at the same time rather than phasing out the health coverage and state insurance exchanges overtime. In an op-ed published in Capitol Hill trade publication The Hill, Paul wrote that Obamacare's financial problems will only get worse as the GOP hashes out its own replacement ideas and Republicans will get the blame. "Mark my words, Obamacare will continue to unravel and wreak havoc for years to come," he wrote. "My fear is that if you leave part of Obamacare in place . . . then you will see an acceleration of adverse selection and ultimately mass bankruptcy of the heathcare insurance industry."
Although many Republicans may hate the idea of retaining any aspects of the ACA, its not just the millions who would lose insurance that they are worried about. They also must craft the bill in a way that doesn't increase the deficit.
Many had assumed that the upcoming repeal bill would be largely identical to the repeal passed by Congress last year, Capitol Hill press reports citing people familiar with GOP leaders' thinking said some major changes are under consideration, including retaining some of the taxes in the health care law. One retained tax might be the so-cal "Cadillac tax," on high-cost, employer-sponsored health coverage, a major source of revenue in the 2010 health care law. The tax, even though it doesn't kick in until 2020, is hated by businesses and labor unions, as well as Republicans.
But repealing the tax could increase deficits in later years, making the bill vulnerable to challenges based on the Senate's Byrd rule, which bars extraneous matter in reconciliation bills. Some Republicans want to scale back the tax exclusion for employer-sponsored insurance and might want trade that provision for repeal of the Cadillac tax down the road.
The Congressional Budget Office estimated the repeal passed by the Congress last year would have produced some $500 billion in savings over 10 years through ending all the taxes and most of the spending in the health care law. That measure would have extended the exchange subsidies and Medicaid expansion for two years. President Barack Obama vetoed the measure. The CBO said the last repeal would have cut spending by $1.3 trillion and reduced revenue by $833 billion over a decade, primarily by repealing exchange subsidies and the expansion of Medicaid that extends health care coverage; eliminating penalties for not buying health insurance; and ending a payroll tax on high earners, a surtax on net investment income, annual fees on health insurers and other taxes.