House bill is ‘under lock and key’
Senator Rand Paul (R-Kentucky) is publicly calling on House Republican leadership to release their proposal repealing the Affordable Care Act (ACA), further signaling the growing rift within the party around whether to repeal-and-replace the health care law, as promised by the president and top GOP leaders for years, or just reform it.
On Thursday morning, Paul took to Twitter to urge House Republicans to share the full bill with Americans, something he said they have kept concealed.
“What is the House leadership trying to hide?” Paul asked. “My guess is, they are trying to hide their ‘Obamacare Lite’ approach.”
Paul reportedly tried to view the legislation for himself after his series of tweets, but was barred from entry.
An “Obamacare Lite” approach, Paul said, is merely “renaming and keeping parts of Obamacare.” That legislative wrangling, which would include new entitlements and extending the ACA’s Medicaid expansion, are not the “#FullRepeal we promised,” Paul added.
Paul is likely referring to the repeal-and-replace plan leaked last week, which featured a bevy of proposals that drew ire from within the GOP for being a departure from the full repeal promised. Some, like Representative Mark Meadows (R-North Carolina) have promised to vote against anything but a full repeal.
“In order to get it right, if we have to vote against a partial repeal, a partial replacement, we believe that conservatives will understand that vote,” Meadows told USA Today on Wednesday.
A conflict between public opinion and political priorities
For Republicans politicians, full repeal has proved (as President Donald Trump said on Monday) “complicated.” Raucous groups of constituents have descended on town halls nationally in the last several weeks, imploring their elected officials not to fully repeal the health care law, particularly without any immediate replacement.
The conflict between public opinion — a majority of Americans support the ACA — and political priorities has spilled into the GOP’s policymaking effort, widening a nasty schism between its members at the core of the legislation’s drafting and those at its fringes.
“There are too many members of Congress that don’t know the status of ‘where we are,’” said Dave Brat (R-Virginia), in a USA Today interview Wednesday. “So it’s very hard to know what’s coming and if we’re going to do a repeal and replace,” Brat said. “We need more than bullet points, right? We’re all going home having town halls with people putting up red cards in the back of the room yelling at us, so we need some answers.”
In public statements, House Speaker Paul Ryan (R-Wisconsin) has projected an image of unity within in the party, despite the mounting complaints from his colleagues.
“We are in sync,” Ryan said during his weekly briefing on Thursday. “The House, the Senate, and the Trump administration.”
Trump’s health care goals differ from congressional leaders’
Ryan’s characterization of his party as “in sync” is belied not only by the statements of other lawmakers, but by those of President Trump as well.
Trump introduced five principles for replacing the ACA in his Tuesday address to Congress, one of which was “access” to health insurance for pre-existing health conditions and tax credits for those who buy their own coverage.
But these goals are far from “in sync” with many of the proposals Republicans have introduced in the past few years, including Ryan’s “A Better Way” proposal, former House member and current Health and Human Services Secretary Tom Price’s “Empowering Patients First Act,” and even Rand Paul’s “Obamacare Replacement Act.” All of those proposals would likely limit access to care, as they repeal the individual mandate, a the tax penalty designed to encourage otherwise healthy people to purchase insurance and thus bring down costs for insurers. And while many of the replacement plans do mandate coverage for pre-existing conditions, most do so with conditions, like two-year time limits.
Republicans have also vehemently criticized introducing tax credits to help people buy insurance, which they see as a new, unnecessary government entitlement.
Without even a basic alignment between the president’s repeal goals and those of the legislators introducing bills, it’s unclear what exactly the ACA repeal plan will ultimately look like — or when it might be formally introduced. Some Republican politicians have called on the president to work harder to unify the party, and suggested that such an effort that could mend rifts within its ranks.
“Nature abhors a vacuum,” Mark Sanford (R-South Carolina) told the Los Angeles Times Thursday. “As a consequence, you’re seeing an attempt to fill in the blanks.”