In a striking change of direction that reveals the can of worms Republicans have opened trying to get rid of the Affordable Care Act, top Republican lawmakers are now shifting their goal on ObamaCare from repealing and replacing the law to the more modest goal of repairing it, The Hill reported Wednesday afternoon.
According to the report, Many of the law’s provisions are so popular that Republicans fear a repeal could have negative repercussions in the mid-term elections.
Lawmakers have already started to face crowds of constituents concerned about what repeal might do to their own healthcare.
As The Hill notes, Twenty million people gained health coverage under ObamaCare, and Republicans have promised that people will not lose their insurance because of repeal.
Some lawmakers are worried the repeal could cause chaos in the insurance market that would be politically damaging to Republicans, or simply that their constituents could lose coverage under repeal. They also want to keep ObamaCare’s taxes in place to provide revenue for a replacement plan, while many others say repealing the taxes is a key part of repeal of the law overall.
There is a split within Republicans over what to do about ObamaCare’s Medicaid expansion, which provided coverage to about 11 million new low-income people.
Lawmakers from the 31 states that accepted the expansion are more likely to want to protect the expansion and the federal money for their states that came with it.
“I’m trying to be accurate on this that we’re going to fix things, we’re going to repair things,” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), a key player on healthcare, said, according to The Hill.
“There are things we can build on and repair, there are things we can completely repeal,” he said.
Senate Health Committee Chairman Lamar Alexander (R-Tenn.) is sounding a similar note.
“I think it is more accurate to say repair ObamaCare because, for example, in the reconciliation procedure that we have in the Senate, we can’t repeal all of ObamaCare,” Alexander said. “ObamaCare wasn’t passed by reconciliation, it can’t be repealed by reconciliation. So we can repair the individual market, which is a good place to start.”
Sen. John Hoeven (R-N.D.), whose state accepted the expansion, said that he wants to keep it while providing more flexibility to states to make changes to the rules of the program, a common Republican goal.
“I think we should keep the Medicaid expansion, but we have to modify it to give the states more control so that they can manage it in a way that works in their state,” Hoeven said, according to The Hill.
Even in the House, Walden acknowledged that some sort of compromise would have to be worked out around Medicaid expansion before Republicans would have enough votes to pass a repeal bill.
“It’s an issue in our conference because we have members whose states took it and members whose states didn’t; we want to be equitable about this,” Walden said. “We’re cognizant of this issue and fundamentally, if we don’t find the right sweet spot, we aren’t going to be able to pass it. I know how to count.”
Another thorny issue is whether to keep ObamaCare’s taxes. Some Republicans, like Sen. Bill Cassidy (R-La.), want to keep the taxes in place to provide revenue for a replacement.
Protections for people with pre-existing conditions and letting young people stay on their parents’ plans until age 26 are also areas Republicans commonly say they want to keep, though how to go about offering pre-existing condition protections is an open question.
Sen. Ron Johnson (R-Wis.) has gone so far as to explicitly reject the slogan of “repeal and replace.” He told CNBC last month that he wants to work with Democrats to “fix” ObamaCare.
“It’s way more complex than simply ‘repeal and replace,’ ” Johnson said. “That’s a fun little buzzword, but it’s just not accurate,” he said, The Hill writes.