By some counts, Republicans in Congress have voted to dismantle all or part of Obamacare more than 60 times since 2011.
All those attempts were rebuffed by Democrats, who controlled the Senate until 2015, and President Barack Obama. But the fate of the 6-year-old law will change rapidly come January, and a Georgian will likely be at the center of the effort to kill it.
President-elect Donald Trump and the Republicans who lead both chambers of Congress have made repealing — and eventually replacing — the Affordable Care Act a top priority.
“It’s pretty high on our agenda, as you know,” Senate Majority Leader Mitch McConnell, R-Ky., said Wednesday. “I would be shocked if we didn’t move forward and keep our commitment to the American people.”
The fast-track procedure Republicans will most likely use to avoid a Democratic filibuster in the Senate puts Georgia U.S. Rep. Tom Price at the center of the effort to undo the law.
“What the American people understand is that the only person standing in the way of Obamacare repeal is President Obama,” the Roswell Republican said in an interview Wednesday. “So when President Obama is gone, there’s a great opportunity to work together.”
As chairman of the House Budget Committee, Price will be in charge of authoring and shepherding a special type of legislation that will allow the GOP to strike broad sections of the Affordable Care Act — the same mechanism Democrats used to advance key portions of the health care law six years ago without the help of the GOP.
Repeal and replace
The undertaking will not be as cut and dried as it may seem, some experts warn.
A byzantine Senate rule limits which types of policies Republicans can strike using the fast-track legislation, raising the prospect that the GOP may need to appeal to Democrats to help kill some portions of the law.
And should the GOP be successful in repealing key sections of the Affordable Care Act on their own, leaving other portions to wither on the vine, there’s the question of what the party will advance in its place.
That uncertainty is likely to lead to lobbying by health stakeholders such as hospitals and insurance providers, as well as the people whose health coverage could be affected.
There is “potentially a lot of anxiety out there for people who are possibly losing their coverage unless they see what exactly the Republicans are proposing to replace it with,” said Kenneth Thorpe, a professor at Emory University who specializes in health policy.
Trump has proposed allowing the sale of health insurance across state lines but has been thin on other details. He's also advocated for expanding the use of tax-free health savings accounts.
House Republicans, meanwhile, unveiled their own proposal last summer that includes creating special insurance pools for people with pre-existing health conditions and turning Medicaid into a block-grant program, which proponents say would give the states more control.
Former U.S. House Speaker Newt Gingrich said Thursday that the House GOP’s health care plan is likely the starting point for Obamacare replacement talks.
“People have been talking about this for four or five years now,” said the onetime Georgia lawmaker and top Trump surrogate. “It’s not like they are suddenly discovering this. … They’ve been holding hearings and consulting experts and talking about how to deal with this for a long time.”
Price, who worked as an orthopedic surgeon before being elected to Congress in 2004, estimated there would be a transition period between the repeal vote and when a replacement plan could be crafted and advanced.
“You can’t just change it overnight,” he said. “What we believe is important is to allow individuals voluntarily to move to the kind of health coverage that they seek for themselves and for their families. We’re not going to force anybody to do anything like the Obama administration has done.”
One budget expert said it is possible that lawmakers will advance a bill to repeal Obamacare and essentially leave a placeholder for a replacement effort to go into effect at a specific date in the future, buying lawmakers time to craft such a new health care plan.
What’s not immediately clear is the impact that an Obamacare repeal would have on the roughly 20 million Americans, including more than 540,000 Georgians, who receive coverage under the Affordable Care Act. Experts say striking the law’s individual mandate will likely reduce the number of people who are covered.
Meanwhile, rumblings about Georgia expanding Medicaid under the Affordable Care Act, an idea that recently caught on in more business-oriented Republican circles, is almost certainly on hold.
State House Speaker David Ralston said moving forward with expansion doesn’t make sense now.“I would not think it’s the thing for us to do to jump on a sinking ship.”
“I don’t know that you’re going to hear very much serious discussion about Medicaid expansion this year,” the Blue Ridge Republican said in an interview Wednesday. “The theme in the national races has been to repeal and replace. We will look at what steps we need to move forward to give people a realistic health care policy rather than an empty promise which is what this entire experiment has been.”
Cindy Zeldin, the executive director of the advocacy group Georgians for a Healthy Future, said repealing the Affordable Care Act and losing the opportunity for Medicaid expansion is unwise.
“Many of the concerns Americans feel about health care are not going to go away,” she said.
“At the end of the day in Georgia, if we rip coverage away from half a million people and lose the opportunity to extend it to more, we’re still going to have to come up with ways to address having high numbers of uninsured with limited access to care, ” she said. “And we’ll have to do it with less resources, and that will only compound it for us at the state level.”