GOP lawmakers debate health insurance options

PHILADELPHIA -- Republican lawmakers aired concerns Thursday inside a private meeting about their party's push to repeal the Patient Protection and Affordable Care Act, according to a recording of the session obtained by The Washington Post.

In the recording, senators and House members expressed a range of concerns about the task ahead: how to prepare a replacement plan that can be ready to launch at the time of repeal; how to avoid deep damage to the health insurance market; how to keep premiums affordable for middle-class families; and how to avoid the political consequences of defunding Planned Parenthood, the women's health care organization.

"We'd better be sure that we're prepared to live with the market we've created" with repeal, said Rep. Tom McClintock, R-Calif. "That's going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we'll be judged in the election less than two years away."

Recordings of closed sessions at the Republican policy retreat in Philadelphia this week were sent late Thursday to the Post and several other news outlets from an anonymous email address. The remarks of all lawmakers quoted in this article were confirmed by their offices or by the lawmakers themselves.

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"Our goal, in my opinion, should be not a quick fix. We can do it rapidly -- but not a quick fix," said Sen. Lamar Alexander, R-Tenn. "We want a long-term solution that lowers costs."

Sen. Rob Portman, R-Ohio, warned his colleagues that the estimated budget savings from passing the Affordable Care Act repeal bill -- which Republicans say could approach a half-trillion dollars -- are needed to fund the costs of setting up a replacement. "This is going to be what we'll need to be able to move to that transition," he said.

Rep. Pete Sessions, R-Texas, worried that one idea floated by Republicans -- a refundable tax credit -- would not work for middle-class families that cannot afford to prepay their premiums and wait for a tax refund.

Republicans also have floated the idea of generating revenue for their plan by taking aim at deductions that allow most Americans to get health insurance through their employers without paying extra taxes on it. Sen. Bill Cassidy, R-La., who has drafted his own bill to help replace the Affordable Care Act, said in response, "It sounds like we are going to be raising taxes on the middle class in order to pay for these new credits."

Rep. Kevin Brady, R-Texas, who chairs a key tax-writing subcommittee, countered, "I don't see it that way," adding that there is "a tax break on employer-sponsored health care and nowhere else" equal to $3.6 billion over 10 years.

"Could you unlock just a small portion at the top to be able to give that freedom [to self-employed Americans]? That is the question," Brady said.

Rep. John Faso, R-N.Y., a freshman congressman from the Hudson Valley, also warned against using the repeal of the Affordable Care Act to also defund Planned Parenthood. "We are just walking into a gigantic political trap if we go down this path of sticking Planned Parenthood in the health insurance bill," he said. "If you want to do it somewhere else, I have no problem, but I think we are creating a political minefield for ourselves -- House and Senate."

Of particular concern to some Republican lawmakers was the plan to use the budget reconciliation process -- which requires only a simple majority vote -- to repeal the existing law, while still needing a filibusterproof vote of 60 in the Senate to enact a replacement.

"The fact is, we cannot repeal Obamacare through reconciliation," McClintock said. "We need to understand exactly, what does that reconciliation market look like? And I haven't heard the answer yet."

Several key policy areas appeared unsettled. While the chairmen of several key committees sketched out various proposals, they did not have a clear plan on how to keep markets viable while also requiring insurers to cover everyone who seeks insurance.

At one point Cassidy, who co-founded a community health clinic in Baton Rouge to serve the uninsured, asked the panelists what he called a "simple question": Will states have the ability to maintain the expanded Medicaid rolls provided for under the Affordable Care Act, which now provide coverage for more than 10 million Americans, and can other states do similar expansions?

"These are decisions we haven't made yet," said House Energy and Commerce Committee Chairman Greg Walden, R-Ore.

Rep. Tom MacArthur, R-N.J., also worried that the plans under GOP consideration could eviscerate coverage for the roughly 20 million Americans now covered through state and federal marketplaces and the law's Medicaid expansion: "We're telling those people that we're not going to pull the rug out from under them, and if we do this too fast, we are in fact going to pull the rug out from under them."

Information for this article was contributed by Robert Costa, Juliet Eilperin and Paul Kane of The Associated Press.

A Section on 01/28/2017

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