The US Senate, under pressure from President-elect Donald Trump, approved a nonbinding budget measure Thursday that could be the first real step toward dismantling President Obama's signature health care law.
Republican leaders in both the House and Senate are pushing forward with a plan to repeal the Affordable Care Act (ACA), known colloquially as Obamacare, perhaps by the end of next month. The House of Representatives is slated to vote on the measure on Friday. But without a cohesive proposal to replace the law, some GOP lawmakers have begun to voice objections, setting the stage for intra-party friction for the incoming administration.
"We're loading a gun here. I want to know where it's pointed before we start the process," Rep. Tom MacArthur (R) of New Jersey said. The centrist leader added that he would oppose the budget measure because of a lack of information about a replacement to the law.
Influential conservative Rep. Mark Meadows (R) of North Carolina, chairman of the House Freedom Caucus, said GOP lawmakers should hitch their "repeal and replace" mantra together into a package deal, rather than considering each piece separately.
"We need to be voting for a replacement plan at the same time that we vote for repeal," Representative Meadows said.
Even so, Senate Majority Leader Mitch McConnell (R) of Kentucky and House Majority Leader Kevin McCarthy (R) of California are charting a course full-steam toward repeal.
"We must act quickly to bring relief to the American people," Senator McConnell said.
A recent poll by Kaiser Health found that almost half of the American public, 49 percent, favors repealing Obamacare – but even among those in that group, a significant majority, about 60 percent, says lawmakers should hash out the details of a replacement before jettisoning the existing law.
"People in this country need to understand what it is they're being asked to substitute for what's there now so they can have an informed opinion about whether it's better or not," Dr. Andrew Gurman, the president of the American Medical Association, told NPR last week.
The operating assumption among Republicans is that repealing the law first, then imposing a transition deadline, will force Democrats to a compromise, as The Christian Science Monitor's Francine Kiefer reported last week. Democrats, meanwhile, are preparing a nationwide defense strategy to tout the law's benefits, which they say has decelerated coverage costs for most Americans who have insurance through work. About 20 million previously uninsured Americans have gained coverage through the 2010 law.
"This is not pretend anymore. This is real life, with real consequences, for real people," Sen. Debbie Stabenow (D) of Michigan said.
Democrats – who have picked Sunday as a national "day of action" to protest the GOP's actions and plans – believe they still have a prospect of halting a repeal vote in the Senate, since they would need only three Republicans to defect.
The Senate's vote early Thursday was 51-48, essentially along party lines; the measure instructs committees in both chambers to draft repeal legislation by Jan. 27. Both chambers would then have to approve the legislation before a repeal would take effect. Republicans in the Senate are using special budgetary procedures to enable an Obamacare repeal with only a simple majority, rather than needing the typical 60 votes required for most legislation.
Sen. Rand Paul (R) of Kentucky was the only GOP senator, out of 52, to vote against the budgetary proposal.
"As a physician, I cannot wait to repeal Obamacare and replace it with a health care system that relies on freedom to provide quality, comprehensive, and affordable care," Senator Paul said in a statement. "But putting nearly $10 trillion more in debt on the American people's backs through a budget that never balances is not the way to get there. It is the exact opposite of the change Republicans promised, and I cannot support it, even as a placeholder."
Mr. Trump said during a press conference Wednesday – his first in nearly six months – that his team would proffer a replacement health care proposal as soon as Rep. Tom Price (R) of Georgia is confirmed as his pick to head the Department of Health and Human Services. Asked for details about what the plan will provide, Trump offered none, but insisted a new law would supplant the current one with virtually no time gap.
"We're going to do repeal and replace, very complicated stuff," he told reporters.
This report contains material from Reuters and the Associated Press.