Paul Ryan, Mike Pence tout ACA repeal despite rising doubts about delayed replacement

Speaking on Capitol Hill Wednesday, two top Republicans doubled down on their promise to dismantle the Affordable Care Act—despite growing concerns about the dangers of a delayed replacement.

“We are starting today on our work to deliver relief to Americans struggling under Obamacare,” House Speaker Paul Ryan said. “The law is failing while we speak. We need to reverse the damage that has been done.”

On Tuesday, Senate Budget Committee Mike Enzi introduced a resolution that includes instructions for House and Senate committees to craft an ACA repeal through the budget reconciliation process. Ryan said the Senate will vote next week to further the process, followed by the House.

For his part, Vice President-elect Mike Pence promised Wednesday that Republicans will bring in an “orderly transition to something better” than President Barack Obama’s signature legislation.  “We’re going to repeal Obamacare and replace it with solutions that lower the cost of health insurance without growing the size of government,” he added.

Some conservatives, though, are expressing doubts about Republican leaders’ “repeal and delay” strategy, which is designed to give them time to hammer out a viable replacement.

In an opinion piece published this week by Rare, Republican Sen. Rand Paul of Kentucky writes that “if Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of Obamacare.”

Two members of the right-leaning American Enterprise Institute expressed a similar sentiment, arguing in a Health Affairs Blog post that a simultaneous repeal and replacement offers the best chance of moving in a better direction on healthcare policy without “unnecessarily creating chaos during the transition.”

To J.B. Silvers, a Case Western University professor and former CEO of the insurance company QualChoice, policymakers’ best bet is to reduce health insurers’ level of risk in the individual market during the transition away from the ACA, he writes in a piece for The Conversation.

That means they must reaffirm a stable set of operating arrangements and the mechanisms designed to reduce risk, he said, warning that “blind talk of repeal with no clear way to build confidence among the private insurers, which will be needed in the replace phase, leads to market failure.”