WASHINGTON — President Obama returned to Capitol Hill Wednesday to rally battered Democrats to defend his health care law, urging lawmakers to stand up to Republicans who are intent on unwinding the crowning domestic achievement of his presidency.
The president sketched out a hopeful strategy for his allies, arguing that Democrats are now in a position to make sure that the party in power in 2017 — the Republicans — would pay a steep price if it takes steps that would further disrupt Americans’ health insurance.
“The president made it clear the politics are on our side,” said Representative Elijah Cummings of Maryland.
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Republicans have passed dozens upon dozens of symbolic measures to repeal the health care law known as Obamacare during his tenure, and President-elect Donald Trump repeatedly pilloried the landmark law on the stump in 2016. But now Trump and the GOP face real consequences for their actions and risk a political disaster if they wade into the health care morass without offering a replacement law that avoids enraging voters and creating chaos in local health care markets.
No clear replacement has emerged from the Republican side, though top GOP officials insist they will have one.
Democrats stung by the outcome of the November elections appeared to relish the upcoming battle. Caucus leaders emerged from their meeting with Obama trumpeting a new slogan that mocked Trump’s “make America great again’’ campaign cry, denouncing GOP plans that they say will “make America sick again.” They’re planning rallies and events around the country to underscore what GOP repeal could cost Americans in specific communities, including millions losing insurance and skyrocketing premiums.
Republicans indeed face a task that is far more difficult than their campaign promises to eliminate Obamacare, which has expanded coverage to about 20 million Americans since it was passed in 2009.
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On the campaign trail, Trump vowed he would repeal Obamacare and replace it with something “beautiful” and “terrific” but never provided any details. But Trump raised a cautionary flag Wednesday, warning congressional Republicans in a series of tweets not to maneuver themselves into assuming political ownership of “the failed Obamacare disaster.”
“Don’t let the Schumer clowns out of this web . . . massive increases of Obamacare will take place this year and Dems are to blame for the mess. It will fall of its own weight — be careful!” Trump blasted out, referring to Senate minority leader Chuck Schumer of New York, as Obama kicked off his huddle with House and Senate Democrats.
Congressional Republicans set in motion this week the procedural maneuvers they will use to ditch key provisions of the law. But neither Trump nor congressional Republicans have offered a specific plan or even rough bullet points of what their replacement health proposal would look like, or when the switch would occur.
GOP leaders on the Hill are leaning toward what’s been dubbed a “repeal and delay” strategy, voting relatively quickly to abolish the law, but with a delayed effective date —
But even that approach seems fluid, with some Republicans worried the uncertainty it would trigger could lead to painful disruptions in the health care marketplace for which voters would blame Republicans.
Maine Senator Susan Collins, a moderate Republican, is among those who have expressed uneasiness about repealing Obamacare without replacement legislation in hand.
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“It would be far better to have a detailed framework,” she said Wednesday, noting her concern that people may lose coverage.
Asked if she thought lawmakers would know what the replacement would look like as they march toward repeal, she answered: “I don’t know. I think we’re making some progress on that.”
It would take the defection of a small handful of Senate Republicans to derail the Obamacare repeal plans.
GOP leaders are planning to use a procedural maneuver known as “budget reconciliation” to cancel key elements of the law, including the so-called individual mandate that people obtain coverage and the subsidies it provides to help people pay for it. Reconciliation requires a mere simple majority — 51 votes —
“If Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of Obamacare,” Kentucky GOP Senator Rand Paul wrote in an op-ed Tuesday.
“We will know what the replacement is” when the vote for repeal happens, said Arizona Republican John McCain, another senator who voiced concerns Tuesday about moving forward without a clear substitute drawn up.
Vice President-elect Mike Pence, expected to be a frequent presence on the Hill after Inauguration Day, met with Republicans in both chambers Wednesday. He said the goal of a new GOP health plan would be to lower costs of health insurance without increasing the size of government. Trump’s incoming administration is working “very closely” with Senate leadership on repeal legislation as well as a framework for creating an Obamacare replacement, Pence said, though he offered no details.
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Pence noted that Trump has supported elements of past GOP health bills such as boosting health-savings accounts and allowing people to buy insurance across state lines. “The architecture of the replacement of Obamacare will come together as it should through the legislative process in the weeks and months ahead,” Pence said.
In addition, he said executive orders are in the works for Trump to sign that would “ensure that there is an orderly transition” to a new health care system.
Democrats are seizing on the lack of details as the crux of their messaging war. Depending on the details of the GOP repeal measure, there’s a risk insurers could decide to pull out of the health care marketplaces even before Obamacare officially ended, among other unintended consequences.
“Republicans would create calamity in the healthcare system because they are stuck between a rock and a hard place, and have no idea what to put in place of the Affordable Care Act,” Schumer said.
Part of the difficulty facing Republicans is that many elements of Obamacare are interlocking and cannot survive alone. The ban on insurers denying coverage based on preexisting conditions, for instance, was put in place in tandem with the requirement that everyone obtain insurance or face a tax penalty. That “individual mandate’’ is needed to make sure that not just sick people sign up for insurance. If healthy people are not paying premiums, and too many sick people are enrolled, an insurance market cannot function at a reasonable cost.
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Most Republicans deeply oppose the individual mandate, but many —
Top Republicans nevertheless dismissed warnings from Democrats and corners of their own party that their approach would backfire politically.
“We’re not going to replace Obamacare with another big gigantic government program with unintended results,” said Texas Republican John Cornyn, a member of the Senate GOP leadership.
“We’re going to provide people with more choices and access to affordable care through the insurance markets,” he said. By hoping Republicans fail in their bid to replace the health law, Democrats are “praying and hoping for more pain on the part of the American people. I would hope they would get past that and agree to work with us.”
Globe correspondent Tyler Pager contributed to this report. Victoria McGrane can be reached at victoria.mcgrane@globe.com. Follow her on Twitter @vgmac.