Behind closed doors, Republicans worry about replacing Obamacare

Republican lawmakers are uncertain about how to reshape the nation’s healthcare system and anxious about the consequences if they don’t figure it out soon, a leaked recording of a closed-door meeting shows.

The meeting, held during a party retreat in Philadelphia on Thursday, finds GOP senators and representatives wringing their hands about questions like how to preserve the stability of healthcare markets as well as costs for those with Obamacare coverage; how to avoid political minefields on funding for Medicaid and Planned Parenthood; how to secure Democratic support for a plan and whether they can do it all before Obamacare is repealed.

The release of the recording comes as GOP leaders and the White House put their foot to the accelerator, racing toward a legislative repeal of the Affordable Care Act accompanied by executive actions from President Trump. And with Republican policy committees offering little in the way of firm solutions, the tape highlights both the enormous complexity of the transition and the uncertainty of what, exactly, the nation’s healthcare system might become.

One source of concern for the lawmakers in the meeting was how fast a replacement for Obamacare would need to be put together.

“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) of Tennessee, according to Washington Post quotes from the recording. “We want a long-term solution that lowers costs.”

President Trump has offered promises to replace Obamacare without creating lags that could leave Americans exposed. But his positions on key items, like the individual mandate, have varied.

Legislative solutions are floating around Congress, as The Christian Science Monitor’s Francine Kiefer reported this week. One authored by Sen. Susan Collins (R) of Maine and Sen. Bill Cassidy (R) of Louisiana – and shot down by Democrats – would use a “state-choice” strategy that leaves out the individual mandate to buy coverage, combined with some more liberal tenets:

The bill’s key alternative option for states would do away with individual and employer mandates and benefit requirements, and instead auto-enroll everyone who isn’t covered by employer or public healthcare in a basic package.

That package would include individual, federally funded health savings accounts, a high-deductible health plan, and a basic pharmacy benefit. People could opt out of the plan, or purchase more insurance. This alternative would enlarge the pool of covered customers, the bill’s authors explain, theoretically covering all of a state's uninsured population.

It would keep the popular parts of the Affordable Care Act, including no lifetime caps on care, no prohibition of pre-existing conditions, and allowing young adults to stay on their parents’ insurance.

And it would reportedly be paid for with the taxes and Medicare savings that now fund the Affordable Care Act. States would also receive funding for the current law’s Medicaid expansion – even if they do not expand Medicaid.

One of the lawmakers who raised doubts in the Thursday meeting, Rep. Tom MacArthur (R) of New Jersey questioned whether moving too fast would “pull the rug out from under” Americans covered under the Affordable Care Act’s state and federal marketplaces or its expanded Medicaid provisions. Rep. John Faso (R) of New York warned of a “gigantic political trap” if a replacement system defunds Planned Parenthood.

And Rep. Tom McClintock (R) of California cautioned that the party needed to be able to stand behind whatever system would be created by new legislation.

“[It’s] going to be called Trumpcare,” he said, according to the Post. “Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.”