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House Leaders Emphasize Executive Branch’s Power Over Obamacare

Speaker of the House Paul Ryan, R-Wisc., holds his weekly press conference in the Capitol on Thursday, Jan. 5, 2017. (Bill Clark/CQ Roll Call)
Speaker of the House Paul Ryan, R-Wisc., holds his weekly press conference in the Capitol on Thursday, Jan. 5, 2017. (Bill Clark/CQ Roll Call)

House Republicans on Thursday emphasized that their efforts to repeal and replace the health care law will rely heavily on revised interpretations of the law that they can make administratively, a sign of the challenges in writing replacement legislation that can overcome the Senate’s 60-vote threshold.

“Let’s not forget, we now have an HHS, an administration, that is ready to work with us to fix this problem,” House Speaker Paul D. Ryan, R-Wis., said at his weekly press conference. “What I think people are beginning to appreciate is we have lots of tools in front of us. It’s not just a one-and-done bill kind of a thing. That is what we’ve been walking our members through — all the options available to us to get this done.”

The comments echo those of President-elect Donald Trump, who on Wednesday suggested Republicans would move more aggressively toward their efforts to repeal and replace the 2010 law after Rep. Tom Price, R-Ga., Trump’s pick to helm Health and Human Services, is confirmed.

Ryan, echoing comments earlier in the day from House Majority Whip Kevin McCarthy, R-Calif., suggested the GOP’s replacement efforts would not be one massive measure but rather a series of policies implemented through a combination of reconciliation and regular order, as well as executive actions.

“It’s not like you have to have this one big bill,” McCarthy said.

That strategy hints at the difficulties Republicans will face, even with majorities in both chambers, if they try to pass major health legislation through regular order, which would require the support of at least eight Senate Democrats to clear the upper chamber. The GOP is relying on a special maneuver that bypasses the Senate filibuster in order to repeal the many parts of the health law (PL 111-148, PL 111-152).

But the multi-pronged approach is at least rhetorically at odds with Trump’s calls on Wednesday to repeal and replace the law “almost simultaneously.” He suggested in his press conference the two actions “could come in the same hour.”

Ryan, however, pushed back on the distance between his plans and Trump’s, suggesting that Trump was merely describing Republicans’ commitment to “move these things concurrently.”

“We’re in complete sync,” Ryan said.

Administrative ‘Relief’

Ryan pledged quick administrative action.

“We are now are getting an administration that wants to provide people relief, that’s not lashing people to the mast of Obamacare, which is sinking — and we believe the administration will have the ability to give a lot of regulatory relief,” Ryan said. “With the new administration working with us, we can get some quick relief so that people can finally find something that they can afford. That’s just not the case these days.”

Those comments echo earlier remarks from Vice President-elect Mike Pence, who promised last week the administration would move as quickly as day one to stabilize the health care marketplaces and begin to unravel the law.

Trump, Ryan and Senate Majority Leader Mitch McConnell of Kentucky regularly decry the health care law as unworkable and collapsing.

Lawmakers provided little clarity on exactly what kind of administrative actions HHS or the White House might pursue. Health industry lobbyists and congressional staffers say final decisions have not yet been made.

Several lawmakers, including Senate Health, Education, Labor and Pension Committee Chairman Lamar Alexander, R-Tenn., have suggested Price could begin by scaling back the so-called minimum essential health benefits insurers are required to cover under the law. Such a change would require only a notice-and-comment period at the agency. Alexander also said HHS could use waivers to adjust health law or Medicaid requirements.

Insurance companies and other industry groups also have outlined further regulatory changes that might help bring down premiums or deductibles during a transition period, including tightening the rules that let people sign up for coverage outside of the yearly open enrollment period or amending regulations that require insurers to keep covering individuals who are behind on their premium payments during a 60-day grace period.

Other experts have suggested the secretary could relax rules requiring adequate networks of providers or change their interpretation of the limits for consumers’ out-of-pocket spending to be more favorable to the insurance industry.

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