WASHINGTON – Congress took its first step toward rolling back President Obama's health care reform law Friday, with the House voting along party lines to pass key preliminary legislation.
The measure, which was passed Thursday by the Senate, will allow Republicans to use special budget procedures to repeal major parts of the Affordable Care Act without cooperation from Democrats.
House Republicans from divergent wings of the party had raised concerns this week about taking the initial step without having a more detailed plan in place for ultimately replacing Obamacare with a GOP alternative.
But House leaders worked in recent days to address those concerns, even as President-elect Donald Trump made public statements setting out an ambitious timeline for action that many on Capitol Hill see as unrealistic. The final vote was 227 to 198.
House Speaker Paul Ryan, R-Wis., said in a Friday floor speech that the measure set to be passed Friday would launch a "thoughtful, step-by-step process" toward replacing Obamacare.
"This is a critical first step toward delivering relief to Americans who are struggling under this law," he said. "In the weeks ahead, several steps will be taken to provide relief – some steps will be taken by this body; some steps will be taken . . . by the new administration.
"Our goal is a truly patient-centered system, which means more options to choose from, lower costs and greater control over your coverage," he continued. "And as we work to get there, we will make sure that there is a stable transition period so that people don't have the rug pulled out from under them."
Ryan said during a nationally televised town hall meeting Friday that Congress would act "definitely within these first 100 days" on a replacement plan.
A few House Republicans remained wary Friday morning of voting on the budget measure containing the ACA rollback instructions without further assurances on the path ahead.
"I still have reservations, I'll put it that way," said Rep. Charlie Dent, R-Pa., a co-chairman of the moderate Tuesday Group, who pushed GOP leaders to delay the budget vote till after a party retreat later this month.
But a number of skeptical Republicans polled Friday said they had gotten sufficient assurances on the process ahead that they would vote "yes." Many of the holdouts are members of the hard-right Freedom Caucus concerned about the fiscal implications of the budget measure, but key members of that caucus said they would support it.
One lawmaker familiar with behind-the-scenes GOP discussions said leaders have pledged to hold a vote on a replacement bill alongside the legislation to repeal Obamacare. Leaders also promised, the lawmaker said, to include in that repeal bill – which would be subject to the special budget procedures – as much of a replacement plan as Senate rules allow.
Under those procedures, known as reconciliation, only provisions with definitive budgetary impacts can be included in the bill.
"We've been showing more of the details, but a lot of this is going to be done in committee," said Rep. Steve Scalise, R-La., the majority whip. "We're not going to be like what [Democratic leader] Nancy Pelosi did, where she wrote the bill in a backroom, dumped it on the floor and said, 'Pass the bill to find out what's in it.' We're actually going to have our committees write the bill in open hearings. I think that's going to be refreshing."
Pelosi, D-Calif., who as House speaker muscled the Obamacare legislation through in 2009 and 2010, is now leading the opposition to its repeal as minority leader.
On the House floor Friday, she dismissed the "mythology" surrounding the ACA – which did, in fact, move through congressional committees, though without GOP cooperation – and accused Republicans of "feeding their ideological obsession with repealing the ACA and dismantling the health and economic security of hardworking families" without coming up with a workable alternative.
"They talk about repeal and replacing," Pelosi said. "For six years, they have had a chance to propose an alternative. We see nothing."
Budget measures such as the one under consideration Friday are typically strictly partisan affairs. Republicans hold a 24-vote advantage over Democrats in the House; if more than a handful of Republicans had balked, GOP leaders would have faced an embarrassing delay.
Republicans got a nudge this week from conservative activist groups, including the Club for Growth and Heritage Action for America, who called for the budget measure's passage. And Trump himself took to Twitter to hail its passage in the Senate.
But for most rank-and-file Republicans, the choice was relatively simple: After running campaign after campaign against Obamacare, would they really pass up their first chance to unravel it?
"If there's been one promise that Republicans have run on for the last six years, it is that we are going to do our best to repeal Obamacare," said Rep. Mark Walker, R-N.C., chairman of the conservative Republican Study Committee. "I think that [the Friday vote] affirms our promise today."