quarta-feira, 4 de janeiro de 2017

Senate Moves to Dismantle Health Law

Senate Moves to Dismantle Health Law
GOP-led chamber sets aggressive timeline for repealing Barack Obama’s Affordable Care Act that cut the ranks of the uninsured
Updated Jan. 3, 2017 10:10 p.m. ET

WASHINGTON—The Republican-controlled Senate on Tuesday took its first step toward dismantling the 2010 Affordable Care Act, using its initial day in office to introduce a measure that sets an aggressive timeline for developing plans to repeal much of President Barack Obama’s signature health law.

Republicans have long said that they would move toward repealing the health law on Day One if they returned to power, arguing that the law is collapsing as some premiums surge and many insurers on the exchanges created by the law stop writing policies. The Senate action came shortly after lawmakers were sworn in for the new session of Congress.

The action came on a day that showed both discord and unity among Republicans at a moment when they will have control of both Congress and the White House for the first time in a decade.

Creating unexpected friction, House Republicans triggered a battle with House Speaker Paul Ryan and President-elect Donald Trump by advancing and then abandoning a plan to reduce the independence of a House office that investigates ethics violations. House GOP lawmakers said the office had acted unfairly, but Mr. Ryan opposed the move, and Mr. Trump urged the party to turn toward other priorities.


Rep. Paul Ryan (R., Wis.) won re-election as House speaker Tuesday in a 239-189 vote that showed House Republicans to be unified as their party takes the reins of power in Washington. Photo: AP
Shortly after the proposed ethics plan collapsed, Mr. Ryan won re-election as House speaker with the support of all but one Republican in the chamber, a show of unity after a fractious election season. Nine Republicans had voted against Mr. Ryan in protest in October 2015, when he succeeded former Rep. John Boehner as speaker, and a number of conservatives had threatened last year to pull their support from him for declining to campaign during the general election with Mr. Trump.

The first fireworks over the repeal of the 2010 health law will begin Wednesday, when Senate Majority Leader Mitch McConnell (R., Ky.) is set to open debate on a measure known as a budget resolution. If approved as expected, it would set in motion a controversial legislative process allowing the GOP to repeal much of the health law with a simple majority vote. Republicans are using the process because they hold 52 seats in the new Senate, short of the 60 needed to approve most legislation.

The Senate debate will take place against a backdrop of high-profile lobbying. President Barack Obama is set to huddle with House and Senate Democrats on Wednesday to discuss strategies to protect the law. Vice President-elect Mike Pence plans to meet separately with House and then Senate Republicans to discuss the GOP’s own plans.

A repeal effort could create upheaval in the insurance markets and the loss of coverage for millions of Americans. It could also could spark a backlash in the 2018 elections.

Republicans have seized on their control of the major levers of power in Washington to deliver on a key campaign pledge to repeal the law. But while starting the repeal machinery, they don’t yet know their endgame.

It remains unclear whether lawmakers will follow through on eliminating the ACA without having a replacement for a law that delivered health coverage to roughly 19 million previously uninsured people, mostly through an expansion of the Medicaid program for low-income Americans, and that sharply lowered the U.S. uninsured rate. What might replace the law remains undetermined.

The Senate’s budget resolution directs four relevant committees, two in the Senate and two in the House, to write legislation by Jan. 27 that reconciles spending and tax policy with the budget blueprint for the coming fiscal year. Embedded in the committees’ legislation will be provisions that repeal much of the health law.

The result will be a single piece of legislation known as a reconciliation bill—a privileged piece of legislation that can be approved in the Senate with a simple majority.

The House has already voted 89 times to repeal the law, but its efforts have been stymied by the Senate.

In 2015, the Senate used the same procedure to repeal large parts of the Affordable Care Act, and by 2016 the House had passed the measure. Mr. Obama vetoed it. Congress sealed passage of the 2010 health law by passing a related measure that also relied on the procedural tactic.

Mr. Ryan, in a statement, said the new Senate measure “sets the stage for repeal, followed by a stable transition to a better health care system.’’

Democrats said that it was up to the GOP to lay out what would replace the health law. Even the most vulnerable Democrats—centrist lawmakers up for re-election in conservative states in 2018—said they wouldn’t go along with the GOP plan to repeal the health law before some replacement was ready.

“I’m not opposed to repealing as long as I had something that would replace it,” said Sen. Joe Manchin (D., W.Va.). “But right now, there’s nothing on the table.”

Rep. Kevin Cramer (R., N.D.), a member of the Energy and Commerce panel, said the most pressing question would be how long to make the transition to a new health-care system. “The biggest issue for all of us on Obamacare is going to be the speed with which we replace it,” said Mr. Cramer.

The budget resolution and reconciliation process can be used to repeal only portions of the Affordable Care Act, among them provisions that require individuals to obtain coverage, that provide tax credits for people to buy coverage, and that direct employers to offer insurance or pay penalties.

It isn’t expected to include measures that would replace the health law with a new insurance program. Some Republicans have said they want to repeal the law in order to create political pressure on lawmakers to write a replacement plan, but the details of such a plan have yet to be determined.

“Obamacare over-promised and under-delivered,” Sen. Chuck Grassley (R., Iowa) said in a statement.

“At every step of this process, I plan to keep in mind how Congress and the incoming president can best deliver for the millions of Americans counting on us to act to repeal Obamacare while protecting access to medical care for all Americans,” he said.

House Minority Leader Nancy Pelosi (D., Calif.) countered: “The purpose of the Affordable Care Act was to lower costs, to improve benefits and to increase access.” She added that “the ACA has made transformational progress in doing all three.”

—Stephanie Armour contributed to this article.

Write to Siobhan Hughes at siobhan.hughes@wsj.com and Kristina Peterson at kristina.peterson@wsj.com

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