GOP leadership to call party dissenters' bluffs to block ACA repeal

The Senate side of the United States Capitol in Washington, D.C.
GOP leaders are hoping a "now or never" approach will prevent possible dissenters from within the party from blocking an ACA repeal.

GOP efforts to repeal the Affordable Care Act have stalled as its members continue to disagree on what comes afterward. But now party leaders in Congress are looking to push through a plan to repeal the law with the assumption that it would not be blocked.

Republicans can’t afford to lose many votes in the House or Senate, according to an article from The Wall Street Journal, but some party leaders see a “now or never” approach as their best chance to repeal the healthcare law while minimizing resistance inside the party.  A number of Republicans have turned on the repeal effort in the wake of concerns about a lack of direction for a replacement plan and a spate of contentious town halls, where constituents came out in large numbers to support the law.

Those pushing for a “now or never” strategy are willing to make some concessions to the dissenters to convince them to hold their nose and vote for the repeal, according to the article.

“You’re a Republican, you’ve been running to repeal Obamacare, they put a repeal bill in front of you ... Are you going to be the Republican senator who prevents Obamacare repeal from being sent to a Republican president who is willing to sign it?” Doug Badger, a Republican leadership health policy adviser, told the publication.

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Party leaders are also hoping to lean on President Donald Trump as a guiding force for the effort, and to rally the troops together for a repeal, but Trump’s approach also has a lack of clear direction on healthcare, according to an article from The Washington Post. Trump has made frequent claims that a sweeping replacement for the ACA is coming under his watch, but he has yet to dive into the nitty-gritty of health policy, instead leaving that to his counterparts in Congress.

Trump is more directly interested in negotiating prices with drugmakers—a policy embraced largely by Democrats but also by some Republicans—than in crafting a replacement healthcare bill.

A draft bill obtained by Politico late last week gives a glimpse into what a potential replacement could look like. The bill would repeal key elements of the ACA, like its individual mandate, essential health benefits, Medicaid expansion and tax subsidies, and instead would champion a Medicaid per capita cap and changes to the rate-banding rule, among other provisions. Such policies that are in line with solutions long-lauded by the party.

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Despite the shifting approach, some in the GOP are skeptical that a repeal will ever materialize, at least not fully. Former House Speaker John Boehner said at the HIMSS conference in Orlando last week that does not believe a full repeal is possible, and that it’s laughable that a comprehensive replacement plan could be developed.

"In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a healthcare proposal should look like. Not once,” Boehner said. “And all this happy talk that went on in November and December and January about repeal, repeal, repeal—yeah, we'll do replace, replace—I started laughing, because if you pass repeal without replace, first, anything that happens is your fault. You broke it.”