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Ryan Says Obamacare Repeal, Replacement Will Happen ‘Concurrently’

Uncertainty over timeline for a replace plan bedevils House GOP

House Speaker Paul D. Ryan says pieces of a health care law replacement plan could be included in the current budget reconciliation measure. (Bill Clark/CQ Roll Call)
House Speaker Paul D. Ryan says pieces of a health care law replacement plan could be included in the current budget reconciliation measure. (Bill Clark/CQ Roll Call)

House Speaker Paul D. Ryan said Tuesday that Republicans will offer a replacement plan for the 2010 health care law at the same time they repeal it, amid signs the legislative process for a repeal was encountering obstacles. 

“It is our goal to bring it all together concurrently,” the Wisconsin Republican said. 

“We’re going to use every tool at our disposal — through legislation, through regulation — to bring replace concurrent along with repeal so we can save people from this mess,” he added.

A growing number of lawmakers are uncomfortable with delaying a replacement plan further after a repeal vote. The interest in moving quickly on both fronts comes from a range of members, including moderates in The Tuesday Group and conservatives in the House Freedom Caucus. 

President-elect Donald Trump weighed in Tuesday in an interview with The New York Times, saying a repeal vote should occur soon — “probably some time next week” — and “the replace will be very quickly or simultaneously, very shortly thereafter.”

Trump was scheduled to meet Tuesday with Georgia GOP Rep. Tom Price, his nominee for Health and Human Services secretary, Seema Verma, his pick to head the Centers for Medicare and Medicaid Services, and Vice President-elect Mike Pence to discuss the push to repeal and replace the law. The group were set to discuss “how to do this,” according to Trump aide Sean Spicer, who noted that was also the topic of a Monday night meetings between Trump’s team and Ryan.

House GOP leadership is whipping support for the fiscal 2017 budget resolution that includes reconciliation instructions for repeal in anticipation of a Friday vote. The four congressional committees with jurisdiction over health care would then draft the reconciliation legislation using a 2015 House Republican repeal bill as a model.

‘There’s problems’

As of Tuesday afternoon, many members were not ready to support the budget resolution, amid confusion about the timeline for a replacement. 

“There’s problems. I mean right now a very large number of members are whipping ‘lean no’ or ‘solid no,’” said New York Republican Rep. Chris Collins, congressional liaison for Trump’s transition team. 

Collins said the potential no votes seem to be coming from members who feel that a replacement plan needs to move at the same time as repeal, reasoning that it may never happen otherwise. Despite the current whip count, Collins expressed optimism that the House will still pass a budget resolution on Friday.  

“Some of it’s confusion, some of it’s going to need some hand-holding,” he said. “That’s what the whip team does. They’ve got baseball bats.”

Virginia GOP Rep. Dave Brat, a member of the Budget Committee and the Freedom Caucus board, said he hopes the budget resolution can pass on Friday. Freedom Caucus members want to vote for it but before they do, they need more details outlining the timetable for repeal and the rough framework of the replacement plan, the Virginia Republican  said. 

“Some folks … are out to scuttle this thing and slow down the process. The Freedom Caucus does not. We want to speed it up,” Brat said. 

The main takeaway from Trump’s comments to the Times on Tuesday is that he does not want to delay the repeal effort as lawmakers come up with a replacement, Collins said. Some Republicans had called for such an approach. 

“We can repeal it quickly and replace it in a timely fashion,” Collins said. “And I would like the sense of urgency to be, personally, six months. I’ve been somewhat ridiculed by my fellow members saying, ‘No, it will take at least a year.’ I don’t buy that.”

‘Repeal plus’

Some pieces of the replacement plan could be rolled into the budget reconciliation measure that Republicans plan to use to expedite the process for striking the law, Ryan said. Asked how much, he said, “That’s a question we don’t know the answer to.”

The Senate has more say over what can and cannot be put in a reconciliation measure, Ryan added.

“We will pass as much as we can through whatever vehicle we’ve got, and then we’ll pass all the other things through regular order outside of regulation that [will] show you the full scope of what a real replacement effort looks like,” the speaker said. 

A Ryan spokeswoman said the committees will take as long as they need but the goal is to get the reconciliation legislation finished as soon as possible. Members have said they expect a vote on the reconciliation bill to occur by the end of February. 

The question that remains to be answered is whether an effort to include parts of a replacement plan in a repeal bill will be enough to satisfy members who want repeal and replace to occur together. 

“It will allay the concerns of some members; other members, it may not,” said Texas Republican Rep. Bill Flores, former Republican Study Committee chairman.

Flores, however, said he doesn’t believe the budget resolution is in danger, noting that it’s just a “rail car” for moving what Ryan is calling a “repeal plus” bill. 

Members also noted that some parts of the replacement effort can come from executive actions. The health care law makes numerous references to “the secretary shall” or “the secretary may,” providing a lot of latitude to Price if he is confirmed as Health and Human Services secretary, Flores and Oklahoma GOP Rep. Tom Cole said. 

“The power that the secretary has in this system is enormous,” Cole said. 

John T. Bennett contributed to this report. 

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