PHILADELPHIA — Republicans emerged from their Center City retreat
planning to replace Obamacare one step at a time by moving a series of
smaller bills that President Donald Trump might try to bludgeon Senate
Democrats into passing.

House Majority Whip Steve Scalise said Friday that both key committees
involved in replacing the Affordable Care Act would be getting underway with hearings on individual elements.

“We want to bring bills through individually. You know one of the flaws
of Obamacare — and there were many — was that Nancy Pelosi literally
wrote the bill in a room with maybe two or three other people the night
before the vote, and nobody read the bill before they voted on it. We want
bills that can move through — everybody across the country can be reading them,” said Scalise, a Republican from Louisiana.

Scalise’s comments Friday morning lined up with what Energy and Commerce Chairman Greg Walden said the evening before.

“We’d like to do things like health savings accounts. We’d like to do refundable tax credits to move people into affordable health care, which can come about on an improved health exchange,” Walden told reporters Thursday. “So we’re looking at those.” 

“Don’t wait for a big bill,” the Oregon congressman said. “We’re going to take this a piece at a time.”

Walden stressed that GOP lawmakers were on the “same page” as the White House, and said there have been ongoing conversations at the senior staff level.

While the House can pass a deluge of bills gutting and replacing elements of Obamacare with a bare majority of GOP members, the rules of the Senate provide that the only way to get a bill through with only Republican votes is through the budget reconciliation process.

Under that process, policy changes are subject to being stripped out for violating the so-called Byrd Rule. And it can’t be used repeatedly throughout the year. Policy changes would actually need some Democrats to buy in.

Asked if that meant replacement measures might bottleneck in the Senate, Scalise pointed to the importance of Trump and his ability to grab attention and rally constituents.

“I like the idea that we have a president who’s going to be using the
bully pulpit, flying around on Air Force One to those states where
Democrats might want to be standing in the way of their own voters, where Democrats are going to be blocking bills to do things like letting their constituents buy insurance across state lines like they buy every other product,” Scalise said. “If they want to block that, try to play partisan politics, Donald Trump is going to be calling them out in their home states. That’s going to change the game.”

Senate HELP Chairman Lamar Alexander outlined a three-step process that would not roll back all of the 2010 law on the front end, a spokeswoman for the Tennessee Republican told Roll Call.

“Sen. Alexander talked with members about his three-part plan to repair
the damage of Obamacare and how Congress and the Trump administration can work together to give Americans access to truly affordable health care,” the spokeswoman said.

“The first step — which will be discussed in more detail at next Wednesday’s Senate health committee hearing — is to send in a rescue crew to help the 11 million Americans who buy individual insurance and are currently trapped in the collapsing Obamacare exchanges health care market,” the spokeswoman said. “The second is step by step to build better health care systems by moving more decisions out of Washington, D.C, to states and patients. Finally, as reforms become concrete and practical alternatives, Congress can repeal the remaining parts of Obamacare in order to repair the damage it has caused Americans.”

That approach reflects concerns that have been most pronounced on the
Senate side of the Capitol, as Sen. John McCain explained to reporters ahead of Trump’s speech to the joint House-Senate GOP retreat
on Thursday.

“I think the biggest aspect of it is how you replace it and what you
replace it with. The risk of X million people being without care — that’s
the challenge, and to repeal it is easy. To replace it is extremely
difficult,” McCain said. “It took several years for Obamacare to really
be in operation.”

Asked about the commitment to passing an Obamacare replacement bill,
McCain pointed to the particular challenge of not throwing beneficiaries
of the law’s Medicaid expansion off of the health insurance rolls.

“In our discussions here, we have said it’s the number one priority, you
know, so let’s see if we can do it,” McCain of replacement. “This whole
issue of what states expanded Medicaid and which ones didn’t? That is a
thorny issue.”

GOP lawmakers are leaving the retreat still hammering out the details on the health reform plan, especially when it comes to the thorny issue of how to address states that expanded Medicaid under the Affordable Care Act.

Sen. Shelley Moore Capito, said she and other senators from states that expanded Medicaid raised the issue at the forum Thursday morning. The West Virginia Republican said lawmakers did not reach an agreement on how to handle the issue, but said, “I think we’re reaching consensus.”

Capito said she and others emphasized “not rushing, and that we’re making sure that we’re replacing as we are repealing.”

“I think that has a lot of appeal to a lot of people, certainly to me,” Capito said in a phone interview.

There’s also the question of whether it is wise to repeal all of the tax
provisions of the ACA at the outset, given budgetary effects down the
road. Scalise indicated there was a push in that direction.

“If you looked at the bill that we passed a year and a half ago and put
on Barack Obama’s desk, it repealed all of the taxes. We’re going to go
as far as we can go. And again, you’ve got some limitations in the
Senate. But we’re working through that right now and it’s going to be an
exciting process to watch,” Scalise said.

One recurring theme of conversations, according to lawmakers and aides, was the limitations of the Senate. Capito said that the leaders of a health care panel at the retreat, as well as Senate Majority Leader Mitch McConnell, R-Ky., stressed the challenges any legislation faces in the Senate, which was especially important to House members who haven’t worked within the chamber’s procedural confines.

— Lindsey McPherson and Bridget Bowman contributed to this report.