Though Republicans are united in their desire to repeal the Affordable Care Act, President Donald Trump’s push for a speedy replacement is laying bare a widening rift among the party’s members.
One major point of contention: Whether to continue the same level of funding for government-subsidized health insurance—including Medicare, Medicaid and individual marketplace plans—that the ACA offered.
Some of the more fiscally conservative Republicans, including Tom Price, R-Ga., the nominee for Department of Health and Human Services secretary, see ACA-related and entitlement spending as unsustainable, according to the Los Angeles Times. But some Republican governors and senators are worried about a political backlash if millions of Americans lose their coverage.
“It’s going to get really ugly on the Republican side,” one former GOP congressional aide told the publication.
At Republicans’ retreat in Philadelphia this week, lawmakers were lining up behind a plan that would repeal major portions of the law through budget reconciliation, then replace it piecemeal through regulatory action and executive orders by the Trump administration, and bills targeting specific parts of the law, Kaiser Health News reported.
“If you’re waiting for another 2,700-page bill to emerge, you’re going to have to wait until the sun doesn’t come up, because that’s not how we’re going to do it,” said Rep. Greg Walden, R-Ore., who is the chairman of the House Energy and Commerce Committee.
Recent competing healthcare bills, though, showed how challenging it will be for lawmakers to agree on ACA replacement legislation. For example, a bill introduced by moderate Republican Senators Susan Collins and Bill Cassidy—which allows states to keep key ACA provisions if they choose—drew ire from some conservatives. The bill, according to a post on the right-wing blog Freedom Works, “replaces Obamacare with...Obamacare.”
Meanwhile, Trump isn’t making Republicans’ job any easier. His recent executive order, which paves the way for federal agencies to waive certain ACA-related taxes, would eliminate key sources of revenue for the health law and put the GOP in the unenviable position of having to raise taxes, according to Bloomberg.
He’s also set the bar high for an ACA replacement, pledging “insurance for everybody” as well as “a better plan, much better healthcare, much better service treatment, a plan where you can have access to the doctor that you want and the plan that you want."
Speaking to GOP lawmakers on Thursday, Trump also doubled down on his call for quick action, KHN reported. “We have to take care of the American people immediately, so we can’t wait,” he said.