WASHINGTON -- Congress often waits for a new president to take office before it gets down to business. This year, Republicans will drop that custom in their dash to scrap the Patient Protection and Affordable Care Act.
Within hours of the new Congress convening Tuesday, the House plans to adopt a package of rules to clear the way for repealing the health care law and replacing it with as-yet-unspecified measures meant to help people obtain insurance coverage.
"The Obamacare repeal resolution will be the first item up," said Senate Majority Leader Mitch McConnell, R-Ky.
President Barack Obama will travel to the Capitol on Wednesday morning to meet with House and Senate Democrats, according to an invitation sent to lawmakers. The White House is casting it as an effort to unite Democrats behind a plan to protect the law before Republicans have a chance to settle on their own plan for repealing it.
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Republicans hope to make that plan next week, when the House will vote on a budget blueprint that is expected to call for the repeal of the Affordable Care Act, according to a likely timetable sketched out by Rep. Greg Walden, R-Ore., the incoming chairman of the House Energy and Commerce Committee. Walden said that in the week starting Jan. 30, the committee will act on legislation to carry out what is in the blueprint. That bill would be the vehicle for repealing major provisions of the health care law, including the expansion of Medicaid and the mandate to buy health insurance or face IRS fines.
President-elect Donald Trump has called the law an "absolute disaster," and has said he is eager to sign a repeal bill like one Obama vetoed in early 2016.
Rep. Nancy Pelosi of California, the House Democratic leader, said the rules devised by House Republicans were "their opening salvo" against a law that she said had been "successful in meeting its goals of reducing cost, increasing access and improving quality of care."
House Republicans have proposed rules to allow lawmakers to raise a point of order against legislation that causes an increase in certain types of federal spending. But the rules give special protection to bills repealing or altering the Affordable Care Act, even if such bills cause a temporary increase in spending.
Republicans worry that the Congressional Budget Office could count their plan for replacing the law as new spending, making it subject to challenge on the House floor. The exception being written into House rules would help them avoid that possibility.
Pelosi pointed to this provision as evidence that the health care law, as written, saves money. In their version of the rules, she said, "Republicans are admitting that repealing the Affordable Care Act will increase costs."
The Congressional Budget Office said in 2015 that "repealing the ACA would raise federal deficits by $137 billion over the 2016-25 period" -- not only because the government would spend more on Medicare, for older Americans, but also because it would collect less in taxes from high-income households.
The 2010 law, the budget office noted, increased the payroll tax rate for many high-income taxpayers and imposed a surtax on their net investment income. The law also imposed annual fees on health insurers and manufacturers of brand-name drugs and medical devices.
Since the Affordable Care Act passed, about 20 million people have gained coverage, and the uninsured rate has dropped to a historic low of around 9 percent. Some of the coverage gains are from employers offering jobs with health care in a stronger economy, but some experts also credit Obama's law.
If Congress votes to repeal the health care law early in 2017, Republican leaders say, they may delay the effective date for several years, to avoid disrupting coverage for people who have recently gained it.
gop disagreements
Obama and Democrats hope to exploit the Republicans' lack of unity on replacing the health care law as a means of preserving it. Some Republicans want to strip out unpopular provisions while leaving others intact, while other Republicans prefer a start-from-scratch approach.
Obama plans to answer questions about the future of the health care law Friday during a live-streamed event at Blair House, just across Pennsylvania Avenue from the White House.
Defenders of the law have formed a political coalition called "Protect Our Care," bringing together more than 20 groups, including the NAACP and the Service Employees International Union. One of the coalition's objectives is to try to prevent Republicans from repealing the health law without also enacting a replacement. Another goal for Democrats is to pre-empt bigger changes to Medicare and Medicaid long sought by Republicans.
The presentations and coalition are among the policy roadblocks Obama is helping to set up before Trump takes his oath of office Jan. 20. Obama has banned oil drilling off the Atlantic Coast, established new environmental monuments, protected funding for Planned Parenthood clinics, ordered the transfer of detainees from Guantanamo Bay, criticized Israeli settlements and punished Russia for interfering in the recent elections through cyberattacks.
Trump may be able to roll back some, or even most, of those actions, but all of those repeals will take time.
Obama also is filling the ranks of the government with his own appointees; since Election Day, he has named 103 people to senior civil service jobs, boards, key commissions and oversight panels, including the National Council on Disability, the Amtrak board of directors, the Holocaust Memorial Council and the boards of visitors at military academies.
He also is pushing ahead with his goal of freeing nonviolent drug offenders from federal prisons. In the past few weeks, he has commuted the sentences of 232 federal inmates and pardoned 78 others. And Wednesday, he will meet with Democratic lawmakers to discuss ways to protect the Affordable Care Act from efforts by Trump and Republicans to dismantle it.
To many conservatives, Obama is acting out of spite as much as conviction.
"He's doing all this stuff as his legacy," said Newt Gingrich, the former House speaker, comparing Obama to a petulant god in a Wagner opera. "If he goes through three more weeks of this stuff, who is the country going to think is the extremist? Trump or Obama?"
White House aides note that many of the president's last-minute actions were put in motion months or even years before the outcome of the election was clear. And none break from the ideological approach Obama took during his eight years in office.
But they represent a determination to do everything possible before passing the job to Trump, who has vowed to dismantle Obama-era changes. That determination has cheered some of Obama's liberal allies, who wish he could do even more.
"The Republicans are freaking out because all of a sudden Obama is doing a lot of governing," said Matt Bennett, senior vice president for public affairs at the Third Way, a liberal think tank. "They don't like it. I get that. But he's in his right to do it, and he should do it. Is he trying to box Trump in? You bet -- and he should."
Obama's most permanent action may be his order banning oil drilling off the Atlantic Coast, a decision rooted in a 1953 law that experts say will be legally difficult for Trump to reverse. Environmental groups and other liberal advocacy organizations are hoping for more such moves by Obama, up until his last moments in office.
"The Constitution lays out that the president is president to Jan. 20 at noon," said Neera Tanden, president of the Center for American Progress, a liberal think tank in Washington.
Republicans this month are hoping to undo some of Obama's regulations and executive orders using the Congressional Review Act. Many of the regulations they are targeting are environmental rules put in place by the Environmental Protection Agency, including the Clean Power Plan to cut carbon pollution from coal-fired power plants, a clean-water rule that has drawn the ire of farmers. Another rule imposed in December protects nearby streams from coal-mining debris, and Republicans are targeting that, as well.
Republicans' priorities for this month also include the tax code. McConnell and Speaker Paul Ryan, R-Wis., want to simplify laws that they say reward wealthy people with smart accountants as well as corporations that can easily shift profits and jobs overseas. Trump advocated a tax overhaul during the campaign, but with fewer details. He promises a tax cut for every income level, with more low-income families paying no income tax at all.
Ryan has called to transform Medicare with a premium-support approach that would, over time, remake it into a voucherlike program that could require some senior citizens entering the program to buy health insurance on the open market instead of getting coverage through the traditional open-ended program. But Trump said on the campaign trail that he wouldn't cut the program, and Senate Republicans haven't been as enthusiastic either.
Some House conservatives have said they want to overhaul Social Security and slow the program's growth to curb spending. But Trump has said he doesn't want to touch those programs, and Ryan told CBS' 60 Minutes in December that he has no plans to change Social Security.
Information for this article was contributed by Robert Pear and Michael D. Shear of The New York Times and by Mary Clare Jalonick, Alan Fram, Matthew Daly, Josh Lederman, Julie Pace and Ricardo Alonso-Zaldivar of The Associated Press.
A Section on 01/01/2017