Republicans push for outright repeal of Obamacare if GOP can’t agree on health care bill

WASHINGTON - Two Republican senators pressed Friday for their leaders to repeal the Affordable Care Act outright if their party could not coalesce around legislation to revise it, even as Senate Majority Leader Mitch McConnell, R-Ky., and his deputies continued to work on a bill that would keep part of the ACA in place.

The fresh calls for repeal, which echoed an early-morning tweet from President Donald Trump on Friday, underscored the extent to which Republicans remain divided on health care as they head into the Fourth of July recess. Having postponed a vote on one of their signature political promises, senators are headed home without a concrete plan to either defend or disparage.

McConnell is trying to tweak his proposal to make deep cuts in Medicaid while providing tax cuts to companies and wealthy Americans - part of an effort to bring on a handful of conservative and centrist senators who have questioned parts of the bill. But his cause was not helped by Trump's suggestion that Republican senators switch gears and immediately try to repeal the 2010 law, also known as Obamacare, if the impasse for the new health care plan cannot be broken.

The tweet was Trump's first public statement since taking office in favor of bringing down Obamacare with no replacement system in place - a move that could send the U.S. health care system into deep turmoil.

'If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” Trump tweeted.

Trump's call is also at odds with the fallback plan McConnell has threatened should the current effort collapse - which is to work with Democrats.

'Either Republicans will agree and change the status quo, or markets will continue to collapse and we'll have to sit down with Senator Schumer,” McConnell said after a meeting with Trump on Tuesday, referring to Sen. Charles E. Schumer, N.Y., the top Senate Democrat.

Two GOP senators, who have both championed this idea of outright repeal, quickly lauded the president's tweet.

Sen. Ben Sasse, R-Neb., who has been working behind-the-scenes with White House officials on health care issues, drafted a letter to Trump that he released publicly Friday. It suggested that if an agreement is not reached by the day that members return from their weeklong recess, the president should call on Congress to repeal the ACA and work through August to craft a replacement by Labor Day.

Sen. Rand Paul, R-Ky., retweeted Trump on Friday morning. Later, he fired off a second tweet saying he had spoken to Trump and Senate GOP leadership 'about this and agree. Let's keep our word to repeal then work on replacing right away.”

Asked for the majority leader's response to Trump's Friday tweet, a McConnell spokeswoman said she didn't have any new announcements.

Senate Republicans, along with their House counterparts, have repeatedly voted to abolish Obamacare without putting anything in its place, including as recently as 2015. In that Senate vote, only two Republicans dissented: Sens. Mark Kirk, Ill., who lost his reelection bid last year, and Susan Collins, Maine, one of the sharpest GOP critics of the current bill.

After that vote, the Congressional Budget Office projected that such a repeal would add $137 billion to the federal deficit between 2016 and 2025 and leave tens of millions of Americans without insurance at the end of that period.

'In the five years since its enactment, nearly every key provision of the law has taken effect and has been incorporated into final rules and other administrative actions,” the CBO wrote. 'Undoing the ACA would thus be quite complicated.”

Health industry officials have warned that overturning the existing law, which has extended insurance to roughly 20 million Americans and changed the rules under which insurance is offered across the country, would create chaos in a sector that accounts for one-sixth of the U.S. economy.

House Ways and Means Committee Chairman Kevin Brady, R-Texas, dismissed Trump's suggestion that Congress could simply repeal parts of the ACA, then go back and replace them later.

'That doesn't achieve what President Donald Trump set out to do,” he said. 'I really think the Senate's approach - certainly in the House - of not simply repealing but starting to put into place the elements that can make health care affordable ... that should continue to be our goal.”

Procedurally, if Republicans used special budget procedures known as reconciliation to skirt a Democratic filibuster in the Senate in order to repeal the ACA, they could not immediately use the same procedures to replace it - meaning they would have to negotiate with Democrats.

'Democrats, no doubt, would obstruct any fair opportunity to replace the Affordable Care Act in the future,” Brady said during an episode of C-SPAN's 'Newsmakers” set to air Sunday. 'So the very best opportunity to begin this good, thoughtful transition to affordable care is right now in reconciliation.”

But the calls for repeal reflect the anger that Trump and many conservatives feel in the wake of McConnell's move to pull the bill that he had crafted behind closed doors in recent weeks.

Conservatives have attacked that measure, which would cut $772 billion over 10 years from Medicaid, the public insurance program that covers nearly 70 million Americans, while providing $541 billion in tax cuts.

Chip Roy, who directs the Texas Public Policy Foundation's Center for Tenth Amendment Action and used to work as an aide to Sen. Ted Cruz, R-Texas, said he believed that Trump's tweet Friday was indicative of his 'frustration with what's going on Capitol Hill.”

More broadly, GOP senators are expressing unease at the fact that the majority has not made more progress in addressing not only health care but tax reform, spending bills, the debt ceiling and a budget resolution. GOP Sens. David Perdue, Ga., Steve Daines, Mont., Joni Ernst, Iowa, John Kennedy, La., James Lankford, Okla., Mike Lee, Utah, Mike Rounds, S.D., Luther Strange, Ala., Dan Sullivan, Alaska, and Thom Tillis, N.C., sent McConnell a letter Friday asking him to either shorten or cancel the monthlong August recess so they can get more done.

'Delivering meaningful results was never assumed to be easy, but the millions of Americans who placed their confidence in our leadership expect our full and best effort,” the 10 senators wrote.

Senate leaders are rewriting their bill to provide $45 billion to combat opioid addiction and provide more financial assistance to low- and moderate-income Americans. At the same time, they hope to placate the right by further easing the ACA's insurance mandates and allowing higher tax deductions through expanded health savings accounts.

But they have not settled on how they would finance all these changes, since conservatives oppose the centrists' push to preserve one of the bill's current taxes as a way of funneling more money to those who cannot afford health coverage on their own.

On Friday, Brady joined the chorus of conservatives who object to maintaining a 3.2 percent tax on investment income for high earners as a way of providing more money to low-income Americans in the health bill. The current draft repeals or delays all the taxes imposed by the ACA.

Keeping the tax, he said, would a 'tough red flag” if the bill comes back to the House.

'At the end of the day, if Congress isn't willing to eliminate that tax now, why would it do it later?” Brady said. 'The House spoke very clearly: We want those taxes out of the economy. That one especially is a very anti-growth, anti-jobs provision, and certainly doesn't help in health care.”

Given the current impasse, the bill continues to come under attack from both the right and left flanks of the GOP.

On a Friday morning conference call with reporters, officials at several conservative advocacy groups took sharp aim at the Senate bill, arguing that it does not repeal the ACA forcefully enough. They championed some proposed changes by Cruz and other lawmakers to more aggressively target the law's regulatory framework.

'We believe that real repeal means full repeal. Root and branch doesn't mean trimming the hedges, as is currently the case,” said Andy Roth, vice president for government affairs at the Club for Growth.

The activists also defended the decision by a Trump-allied group to target Sen. Dean Heller, R-Nev., with ads over his refusal to back the Senate bill. The move, which the group later reversed, unnerved many Republicans.

Roth noted that his organization spent money targeting House members as that chamber worked on its own health care bill, and he praised the tactic of pressing lawmakers from the outside. But he said he was not ready to pressure senators to back the current bill, because the Club for Growth does not support it.