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Repeal of Obamacare faces obstacles in House, not just in Senate

  • Author: Jennifer Steinhauer, The New York Times
  • Updated: December 2, 2017
  • Published February 23, 2017

WASHINGTON — Ever since Republicans got down to the business of repealing the health care law, the Senate has been singled out as the likely problem. Any plan that could zoom through the House would hit roadblocks among Senate Republicans, many of whom have resisted a wholesale repeal of the health law without a robust replacement plan.

But after weeks of loud protests, boisterous town hall meetings and scores of quieter meetings with health care professionals, patients, caregivers and hospital managers in their districts, it is becoming increasingly likely that a consensus in the House may be just as hard to reach.

The most conservative House members are pushing for a fast repeal of the health law with only a bare-bones replacement to follow, possibly just bigger incentives for people to open health savings accounts to fund their own health needs. Other Republicans are more interested in taking their time to come up with a replacement plan that, as of now, they have failed to cobble together beyond a menu of options.

Activists encourage Sen. Dan Sullivan not to vote to repeal the Affordable Care Act on Wednesday, Feb. 22, 2017, as he speaks to the Anchorage Chamber of Commerce at the Petroleum Club Anchorage. (Bill Roth / Alaska Dispatch News)

Among the increasingly concerned Republicans are those who represent the 24 congressional districts that Hillary Clinton won in the presidential election — roughly the numerical edge Republicans hold over Democrats in the House — and another dozen in districts that President Barack Obama took in 2012 but President Donald Trump won in November. If 25 conservative hard-liners oppose any robust replacement plan, and 30 swing-district House members demand a more generous plan, passage of a compromise bill will be in jeopardy.

"For the first time Republicans need to demonstrate what they are for and not just being against Obamacare," said Doug Heye, who served as the deputy chief of staff to former Rep. Eric Cantor, R-Va., when he was majority leader. Cantor and House Republican chairmen labored in 2014 to bring a replacement bill for Republicans to get behind, Heye said, and got nowhere, even with no stakes.

"Republicans are going to come back to Washington next week and say what they've heard on the ground, at hospitals, at restaurants, at events where people have been concerned about where they go from here," he said. "How much that shapes things over the next months remains to be seen."

Further, recent polls show increasing enthusiasm for the health law as Americans see its repeal on the horizon; an NBC News/Wall Street Journal poll found in January that more people viewed the law as a good idea than as a bad one for the first time since 2009, when the poll commenced.

For Republicans in swing districts in California, New Jersey, New York and other states, the combination is a wicked brew: Those members need to build a winning coalition of base voters who hate the law and independents and crossover voters who have recently cottoned to it.

While the 218 votes needed in the House to get the ball rolling remains likely, it is no longer the slam dunk that Republicans had with previous bills to repeal the law, when lawmakers knew their efforts would die in the Senate or on Obama's desk.

Some Republicans are trying to keep a low profile back home, like Reps. Darrell Issa of California, Martha McSally of Arizona and Will Hurd of Texas, to avoid the hot seat on health care.

Others, like Rep. Greg Walden of Oregon, are smoothing their terms of engagement, increasingly referring more to "repairing" the law than repealing it.

"When you talk about 'repeal,' you have just used a word that is very polarizing," said Rep. Tom MacArthur, R-N.J., who meets weekly with moderate Republicans and Democrats of equal number. "When you go to Democrats and say, 'Help us repeal,' that puts them in a box. If you say, 'Would you help us repair something?' people start listening in a whole other way."

Others are simply taking credit for the law's popular provisions, like the one that prohibits insurers from denying coverage for pre-existing conditions. Rep. Marsha Blackburn, R-Tenn., applauded some of them in a town hall this week and claimed they were added to the law thanks to her party — a claim that is simply not true.

Rep. Scott Taylor, R-Va., when asked about a House Republican health care plan that would not provide maternity coverage, said he would push for such coverage to be included in any replacement plan, one of many examples where Republicans are likely to divide on policy and provisions.

"There's discussion," Taylor said of the plan promoted by House Speaker Paul Ryan. "It's not set in stone yet."

Republicans have been worrying about this long before constituents and protesters began jamming their town hall meetings. Shortly after the election, during a Republican retreat in Pennsylvania, many members privately complained about using the repeal as an avenue to defund Planned Parenthood or repealing without a clear replacement plan, according to a recording of the meeting anonymously provided to The New York Times, The Washington Post and other newspapers.

On Tuesday night, MacArthur — one of only nine Republicans to vote against the initial bill to begin the repeal process last month — met with protesters who have been standing outside his office, largely to discuss health care.

After the meeting, MacArthur found himself outside a basement room where a group of local Democrats had gathered, and he wandered in to chat, he said.

"We had a really good impromptu discussion," MacArthur said. "There are very sincere people in my district who are deeply concerned about where the country is headed and doing what they should do, which is to go to their closest federal representative."

"I think first you do the right thing for the country," he added, "and then you think about the political ramifications and in this case doing the right thing would be less polarizing."