GOP struggles to nail down Obamacare replacement

WASHINGTON—As Republicans move closer to gutting Obamacare, they can’t quite agree on which parts to eliminate and what should replace them.

In his first address to a joint session of Congress on Tuesday night, President Donald Trump outlined several broad principles for a new healthcare system. He called on Congress to act quickly because the Affordable Care Act (ACA) is an “imploding disaster.”

Trump said the new system must guarantee healthcare for people with pre-existing health conditions—one of Obamacare’s most popular selling points. He added there must be a stable transition so Americans don’t lose their coverage and states have the resources to keep low-income Americans insured through Medicaid expansions.

Trump also referenced ideas from draft legislation leaked last week, which proposed the replacement plan include tax credits to help pay for health coverage based on age and not income levels.

The president’s speech came after multiple meetings with governors and a listening session with executives from top insurers Blue Cross Blue Shield, Cigna, and Humana.

During a meeting with Republican Ohio Gov. John Kasich, who challenged Trump on the campaign trail last year, the president seemed to shift his thinking on how to replace Obamacare. During the meeting, his staff mentioned Republican plans in Congress.

“Well, I like this better,” Trump replied, referring to Kasich’s idea of maintaining the expansion of Medicaid funds under Obamacare.

After the Republican draft plan surfaced, a trio of conservative Republican senators—Ted Cruz of Texas, Rand Paul of Kentucky, and Mike Lee of Utah—made a joint statement saying without significant changes, they would not support the legislation. The senators called the draft a watered-down version of Obamacare and not the full repeal they promised their constituents.

Similar statements came from Reps. Mark Walker and Mark Meadows, Republicans from North Carolina who chair the 150-member Republican Study Committee and 40-member House Freedom Caucus, respectively.

Walker explained he couldn’t advise his caucus to support a tax credits plan that created long-term fiscal headaches.

“It kicks the can down the road in the hope that a future Congress will have the political will and fiscal discipline to reduce spending that this Congress apparently lacks,” Walker said. “The bill contains what increasingly appears to be a new health insurance entitlement with a Republican stamp on it.”

On Wednesday, Senate Majority Leader Mitch McConnell, R-Ky., scheduled a special closed-door meeting for the GOP to hash out differences on ACA replacement. The meeting will give the conservative wing of the party time to voice concerns about proposed plans they call “Obamacare-lite.” GOP leadership plans to vote on repealing Obamacare as early as next month and will have to convince unhappy conservatives, who campaigned on a complete repeal of President Barack Obama’s landmark healthcare law, to fall in line. Meanwhile, GOP leadership will attempt to proceed without any cooperation from Democrats and a president still making up his mind on which direction to go.

While Republicans work out their disagreements, they will have to swim upstream against shifting public opinion on the ACA.

Last week, the Pew Research Center unveiled a poll showing 54 percent of Americans approve of Obamacare, while only 43 percent hold a negative opinion of it. And the latest Kaiser Health Tracking Poll found 48 percent of Americans have a favorable opinion of Obamacare, while 42 percent have an unfavorable one. That level of favorability was the ACA’s highest in 60 such polls since 2010.

Ashley Kirzinger, a senior survey analyst for the Kaiser Family Foundation, told me the shift wasn’t large, but the new data was still surprising.

“It’s the first time we’ve got a higher share saying favorable than unfavorable since 2010—and we ask this almost every month,” Kirzinger said. “It’s definitely an indication that something is happening.”

The Kaiser poll showed most Democrats, 81 percent, were worried about the ACA repeal-and-replace process, while 76 percent of surveyed Republicans said they were “hopeful.”

Notably, 45 percent of respondents said they were confused about the process as they observed elected officials debating healthcare policy.

“I think it has a lot to do with the logistics of the legislative process,” Kirzinger said. “People are unsure if this means the ACA, if it’s repealed, will go away immediately or if it’s going to be a long-term process, and they don’t know what that means for the costs of their own premiums.”