Republicans are back to open warfare over Obamacare.
Disparate factions of the GOP are drawing hard lines on what they’re willing to support — or not — when it comes to repealing the health care law. And the sparring raises the question of what, if anything, can pass Congress over the next few weeks.
The more centrist wing of the party wants to slow the entire process down. They say Republicans need to act deliberately to avoid public panic over millions potentially losing their insurance. The party, they argue, needs to put forward a replacement plan — or at least as much of one that can pass using a special, majority-vote mechanism — before it ditches the law. Forget the 2015 repeal bill that Barack Obama vetoed, they add: It’s not relevant now that Republicans own the problem.
“It’s not realistic,” said Sen. Jeff Flake (R-Ariz.) of the 2015 bill. “The imperative is to do it right and I don’t think that does it right. I don’t think you’ll find much currency for that approach in the Senate.”
Conservatives are in a different place entirely. Senate hard-liners are joining with the House Freedom Caucus and some top Republican Study Committee members to demand a back-to-basics approach: Kill the law now, even if there’s no clear picture of what replaces it. On Monday evening the Freedom Caucus made the risky decision to return to pushing the 2015 repeal bill, arguing that it’s already proven it can win majorities in both chambers and clear the Senate’s parliamentary hurdles.
"I think to suggest we could pass it in 2015 but it’s more difficult to do it in 2017 makes for a very difficult argument for anyone as to why they changed their position and were willing to vote for it then but not now,” Freedom Caucus Chairman Mark Meadows (R-N.C.) said during a briefing with reporters.
Conservative senators and aides said that there are enough senators that are insisting on this approach to tank any other repeal effort. Republicans can lose only two votes in the Senate to pass Obamacare repeal on party lines, which they will need to do given strong Democratic opposition to dismantling the law.
“Many of us probably won’t vote for anything less than that,” said Sen. Rand Paul (R-Ky.). “I would guess that there are at least four or five of us in the Senate that won’t vote for anything less … they’ve got to realize that if they want to get repeal, not partial repeal. Everybody voted for it.”
Sen. Mike Lee (R-Utah) agrees, a spokesman said. Sen. Ted Cruz (R-Texas) has also been pushing the party to move faster.
The extent to which the House Freedom Caucus is willing to play hardball is less clear. Several of the group’s members say the 2015 bill is the "minimum" of what they’d support. But they’re not saying unequivocally that they would vote against any reconciliation bill that includes some replacement elements.
Some Freedom Caucus members said they’d support health savings accounts, for instance, but would oppose tax credits to buy insurance. Republican leaders want both ideas included in a replacement package.
"I don’t want to speculate what we would not vote for, but if it does not include at a minimum what it included in 2015… we’re not going to vote for that," said Rep. Raúl Labrador (R-Idaho), a Freedom Caucus member, when asked Tuesday about the group’s official position.
The dissension in the ranks brought House Speaker Paul Ryan (R-Wis.) to the Senate Republican lunch on Tuesday to try and get everyone on the same page, aides said.
The conflict threatens to paralyze the GOP in its long-sought goal to roll back the health-care law, which looked like a gimme after the November election. The 2015 bill may have been able to pass at the beginning of the year with no subsequent replacement, but President Donald Trump gradually rallied the party around gutting the law only when an alternative was ready.
Now conservatives are moving away from that out of fear that policy details about the health care alternative are bogging down repeal.
"I think the American public expected us to act a little quicker than we are," said caucus member Jeff Duncan (R-S.C.).
Senators and aides said that the Freedom Caucus has inserted itself into the debate at an inopportune time.
“They should have done this two months ago,” said a senior GOP official familiar with internal party deliberations. "They are the least strategic" group.
The Republican debate has moved far away from the Freedom Caucus position. Four Republican senators told POLITICO they don’t believe returning to a straight-up repeal, with a two-year transition period away from the Medicaid expansion that millions of low-income voters rely on, is realistic in the Senate.
These senators are discussing a longer, perhaps four-year transition period, from the Medicaid expansion, said Sen. Steve Daines (R-Mont.). That could pit senators from states that have accepted the expansion against repeal hardliners. And other Republicans say they can’t pass a repeal bill without clearly laying out how people that have benefited from Obamacare will be taken care of.
Sen. Lindsey Graham (R-S.C.) says that means allowing people on Obamacare insurance plans to keep them indefinitely until there’s a new law; continuing to bar insurers from denying coverage because of pre-existing conditions; and allowing young adults to stay on their parents’ plans until age 26. Those provisions were not in the 2015 repeal bill, which Graham said was passed “when we knew it wasn’t going to happen” because of Obama’s veto.
“If we repeal Obamacare, we need to make sure people don’t fall through the cracks until we get a replacement,” Graham said. “If those three provisions are in place, repealing the law can be done without completely destroying peoples’ lives.”
Josh Dawsey contributed to this report.