In the News

Congress must repeal Obamacare “within the next two or three months” to avoid the wrath of voters who expected Republicans to ease the anxiety around soaring rates and dwindling insurance options back home, conservative lawmakers said Wednesday.

Replacing the Affordable Care Act’s heavy mandates with free-market reforms that protect the poor and vulnerable is crucial, they said, but lawmakers should clear the decks for that effort by gutting the 2010 law.

“I think we should repeal it first, before deciding what comes next,” Sen. Mike Lee, Utah Republican, said at a roundtable hosted by the conservative Heritage Foundation.

“You don’t even get to what comes next if you don’t first get to repeal,” he said. “I think repeal becomes a lot more difficult if you load it down with all the heavy details involving what comes next, where we don’t have a whole lot of consensus.”

That stance is at odds with what GOP leaders have sketched out so far. They say they want to have a replacement ready to go when they attempt their repeal, because insurance markets need the certainty of what comes next.

President Trump recently told Fox News the effort might stretch into next year, though House leaders said he was referring to the implementation of their plans, which would be legislated this year.

They’re already behind their own self-imposed schedule, however, which called for key committees to have their plans ready by Jan. 27, so budget chairmen could craft fast-track repeal legislation that avoids a Democratic filibuster.

GOP committees have begun to write replacement bills that would stabilize or overhaul the current market and be approved, piece by piece, later in the year.

Rep. Mark Meadows, North Carolina Republican, said the best way to stabilize the insurance market is to “repeal Obamacare,” citing a lack of choices in his state.

“There is one carrier in my district now,” he said.

Rep. Jim Jordan, Ohio Republican, said voters will be furious if the GOP lets its campaign promise of repeal slip any further.

“The biggest problem with waiting is that’s not what we told the voters,” Mr. Jordan said.

Congress already approved a repeal once, in 2015, only to see if vetoed by then-President Obama.

That bill scrapped taxpayer subsidies that help people buy private plans on web-based exchanges, plus the expansion of Medicaid in select states. It also repealed the mandate requiring people to get covered or pay a tax.

Repeal of the coverage provisions was delayed for two years, so the party had enough breathing room to implement their own reforms.

Conservatives said this year’s effort shouldn’t rely on a transition beyond two years, despite concerns that moving too fast would induce market chaos.

“The chaos American people are facing right now is related to a set of circumstances put in place by Obamacare,” Mr. Lee said. “That’s what has created the chaos. I wish there were a non-chaotic path, one that were easy.”

Indeed, Republicans are struggling to coalesce around a replacement plan that can be vetted by budget scorekeepers to see how it stacks up against Obamacare.

One sticking point is how to cover customers who are already sick, while scrapping the Obamacare mandate that required healthier people to enroll in coverage, too, to try and balance out insurers’ costs.

Generally, the GOP says insurers should have to accept people with preexisting medical conditions, so long as those customers have maintained coverage of some form. That way insurers won’t be saddled with consumers who, rather than paying premiums over time, wait until the get sick to sign up and submit costly claims.

“I have not heard any of my colleagues say we should leave those with preexisting conditions out in the cold,” Mr. Meadows said.

Republicans also say customers who are priced out of the market could be covered by “high-risk pools,” although the federal government or states would have to fund them. The House GOP’s “Better Way” plan called for $25 billion in federal funding over 10 years.

Republicans also say insurers should be allowed to provide cheaper plans with fewer benefits than the 2010 overhaul required. Another plan would relax Obamacare rules that prevented insurers from charging older consumers more than three times what they charge younger enrollees, who are needed to curb year-to-year premium hikes in the marketplace.