President-elect Donald Trump demanded on Tuesday that Congress immediately repeal the Affordable Care Act and pass another health law quickly thereafter, issuing a nearly impossible request: replace a health law that took nearly two years to pass with one Republicans would have only weeks to shape.
“We have to get to business,” Trump told The New York Times in a telephone interview. “Obamacare has been a catastrophic event.”
Trump appeared to be unclear both about the timing of already scheduled votes in Congress and about the difficulty of his demand — a repeal vote “probably some time next week” and a replacement “very quickly or simultaneously, very shortly thereafter.”
Republican leaders have made the repeal of President Barack Obama’s signature domestic achievement a top priority, and votes on Thursday in the Senate and Friday in the House would approve parliamentary language crafted to protect legislation to appeal the Affordable Care Act from a filibuster in the Senate.
House Speaker Paul Ryan of Wisconsin, who consults often with Trump, set forth a similar timetable Tuesday, saying that a bill to repeal the health care law would include some legislation to replace aspects of it, though Republicans have yet to agree on the details of their alternative.
“It is our goal to bring it all together concurrently,” Ryan said.
But those ambitions will be difficult to achieve and will almost certainly require Democratic cooperation. Until now, Republicans could vote to repeal Obama’s health law with no fear that they would have to live with the political consequences of scuttling a law that provides health care for 20 million Americans and protects millions more from discrimination for preexisting medical conditions, ends lifetime caps on insurance coverage, and allows children to remain on their parents’ insurance policies until age 26.
With complete control of Washington, what comes next in health policy will belong to the Republican Party. For several days, congressional Republicans of diverse political views — moderates and conservatives alike — have been saying they are nervous about repealing the law without any clear idea of what comes next. Five Senate Republicans have pressed to delay the deadline for a repeal vote until March and several House Republicans are also demanding that the pace slow down.
“In an ideal situation, we would repeal and replace Obamacare simultaneously, but we need to make sure that we have at least a detailed framework that tells the American people what direction we’re headed,” said one of those five Republicans, Senator Susan Collins of Maine.
As it stands, the budget resolution that will fast-track that vote gives Senate and House committees until Jan. 27 to write legislation that would repeal major provisions of the health care law. But the schedule for action on that legislation, its effective date, and the timetable for phasing in a new system of health insurance coverage are all unresolved questions.
Even the Jan. 27 deadline is not enforceable or particularly meaningful, Senate aides said, indicating that Congress could follow any timetable its leaders might prescribe.
That uncertainty apparently convinced Trump to leap into the fray. Not only did he try to steel Republican spines, but he threatened Democrats who might stand in his way, saying he would campaign against them, especially in states that he won in November.
“It may not get approved the first time, and it may not get approved the second time, but the Democrats who will try not to approve it” will be at risk, he said, warning that “they have 10 people coming up” for reelection in 2018. That alluded to Democratic senators in states he won.
“I won some of those states by numbers that nobody has seen. I will be out there campaigning,” he said.
He described the health law as a catastrophe. “I feel that repeal and replace have to be together, for very simply, I think that the Democrats should want to fix Obamacare,” he said. “They cannot live with it, and they have to go together.”
After meeting with House Republicans on Tuesday, Ryan took a similar tone, calling the campaign to repeal the health law “a rescue mission to save families who are getting caught up in the death spiral that has become Obamacare.”
Aides to Ryan said the effort to dismantle the Affordable Care Act would include not only the main bill that would be protected from a filibuster in the Senate, but also legislation that would not enjoy such protections. That legislation would take Democratic cooperation to be passed, because Senate Republicans are eight votes short of a filibuster-proof majority.
Far from a “death spiral,” Obama and congressional Democrats call the Affordable Care Act the best health law since the creation of Medicare and Medicaid in 1965. And the Obama administration reported Tuesday that more than 11.5 million people nationwide had signed up for health insurance or been automatically reenrolled under the Affordable Care Act as of Dec. 24, 2016. Of that total, officials said, more than 8.7 million people came in through HealthCare.gov, the online federal marketplace, and 2.8 million were enrolled in states using their own marketplace platforms.
“Today’s data show that this market is not merely stable, it is actually on track for growth,” Aviva Aron-Dine, a senior counselor to Sylvia Mathews Burwell, the secretary of Health and Human Services, said in a conference call with reporters. “Today we can officially proclaim these death spiral claims dead.”
The fourth annual open enrollment period started on Nov. 1 and ends on Jan. 31, 11 days after Trump’s inauguration.