The biggest emerging obstacle to the Republican plan to change the US healthcare system might be the GOP itself.
Conservative lawmakers are grumbling within their own party over the repeal and replacement of the Affordable Care Act, the law better known as Obamacare.
Arguments over the future of President Barack Obama's signature healthcare law and a tweak in attitude from the administration of President Donald Trump have shifted the Obamacare changes into a slower gear.
A draft of the House GOP’s plan to repeal and replace the law that was leaked to Politico on Friday has already faced pushback from some conservative lawmakers.
Rep. Mark Meadows, the head of the influential House Freedom Caucus, and Mark Walker, the chairman of the Republican Study Committee, said on Monday that he would vote against the leaked draft of the bill if it were introduced. And some Republican senators are on the fence.
A coalition of conservative members, including Sens. Rand Paul, Ted Cruz, and Mike Lee, have all expressed dissatisfaction with the framing of the debate, pressing the need for a total repeal of the law.
Given the budget-reconciliation method Republicans plan to use for much of the law, the GOP only needs a simply 51-vote majority to pass the upper chamber. Without Paul, Cruz, and Lee, however, the party would not have enough votes to get even a reconciliation bill through the body.
On the other end, some GOP senators in states that have expanded the Medicaid program under the law are unhappy with the House version of the bill because it does not preserve the expansion. GOP governors in states with Medicaid expansion have also been critical of any plan that does not continue to provide states with funding to expand the coverage program for low income individuals.
Senate Majority Leader Mitch McConnell, when asked about the timing of Obamacare’s repeal and replacement, told reporters the GOP “was not there yet.”
It's not just Congress. The Trump administration itself has been setting up the possibility of a slower timetable for repealing and replacing Obamacare.
In the days leading up to his inauguration, Trump told the New York Times that he did not want to wait long on healthcare. He said he expected a repeal vote "sometime next week" and a replacement "very quickly or simultaneously, very shortly thereafter."
Now, however, Trump and his team seem to be pumping the brakes on their messaging. They have stressed the difficulty of the repeal process have urged patience.
Trump told a meeting of governors this week that reform was coming soon, but he hinted how surprised he was at the reality of the process' complexity.
"Nobody knew that healthcare would be this complicated," he said.
In an interview with Fox & Friends on Tuesday, Trump also said he hasn’t had enough time to get the replacement done.
"I’ve only been here for like four weeks," Trump said. "Somebody said, 'He hasn’t done healthcare yet,' but they've been working on healthcare for 30 years. I’ve only been here for — what is this, like my fifth week?"
Trump did say, however, that "we're set to propose a plan."
The Washington Post reported last weekend about internal disagreements over the future of the health law within the Oval Office. After meeting with Ohio Republican Gov. John Kasich, who is an advocate of Medicaid expansion and a less aggressive ACA repeal, Trump was reminded that that Kasich's suggestions did not represent the plan GOP leaders were pushing for — to which he reportedly said, "Well, I like this better."
It remains unclear whether the administration will present its own ACA replacement plan. Trump’s administration has held meetings about the ACA with participants such as Health and Human Services Secretary Tom Price and chief of staff Reince Priebus, and Trump promised a plan once Price was confirmed.
CNBC’s John Harwood, however, reported that most Republicans in Congress do not expect a separate plan from the administration and that the legislature will dictate the course of healthcare policy.
With congressional lawmakers arguing over the course of policy and no apparent direction coming from the White House, all eyes will be on Trump’s speech to a joint session of Congress on Tuesday night, when he is, in part, expected to provide details of his vision.
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