Obamacare Repeal's New Twist: The 'Replace Now' Caucus

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Some Senate Republicans say they want to include pieces of an Obamacare replacement in the bill they use to repeal it -- which budget wonks say is possible, but GOP leadership says is unlikely.

Many of the concerned members represent states that expanded Medicaid or are up for reelection in 2018, senators acknowledged -- meaning they have more constituents at risk or could be punished at the polls if the repeal goes awry.

The goal: Right now, members are discussing whether they can or should include the replacement components, which could include a different system for covering people with pre-existing conditions.

The problem: It’s not clear that the rules of “reconciliation” -- which could allow Obamacare repeal to pass with only 51 votes in the Senate -- would allow them to replace anything in the law. It’s better for knocking things out of it.

Budget experts say they could do it, but Republican leaders aren’t convinced they should. Senate Republican Conference Chairman John Thune of South Dakota says the party needs to reach consensus before they move forward on replacement, and the timing of that part is "still an open question."

Some GOP members have already decided they’re supportive of adding in replacement provisions.

• Sen. Bill Cassidy of Louisiana: ”I am meeting with leadership staff next week, and I’ll absolutely push for it.”
• Sen. John McCain of Arizona says pre-existing conditions need to be addressed, including “the replacement of the present system for taking care of people with pre-existing conditions.”
• Sen. Dean Heller of Nevada: If the repeal bill can be “expanded” to include parts of replacement, “I’m pleased with that.”

But so far, leadership is cool to the idea.

Senate Majority Whip John Cornyn of Texas, the number two Republican in the Senate, said the GOP would like to work with Democrats on replacing Obamacare, so they probably won’t try to pass any replacement pieces this early.

And Sen. Roy Blunt of Missouri, the vice chairman of the Senate Republican Conference, said it’s “pretty hard to do a lot of what needs to be done” in reconciliation. So he thinks the repeal bill that will get a vote in January will look “an awful lot like the bill that was put on the president's desk last year.”

HOW IT COULD WORK

Reconciliation rules are insanely complicated. But basically, there are two important things to know:

1. All parts of the bill have to affect spending and revenue.
2. The bill can’t increase the deficit over time.

Doing repeal and replace together is possible, but the Senate parliamentarian has the final say on whether the bill complies with the rules. And some pieces of both repeal and replace definitely can’t be included in reconciliation.

But whether it’s likely is a completely different story. Getting 50 senators and 218 House members to agree on a single replacement strategy at the beginning of the year is quite the task.

IF YOU’RE A WONK…

Cassidy got into some of his ideas about what the pieces of replace could look like, if included. These ideas largely mirror his own Obamacare replace bill.

On subsidies: Replace Obamacare subsidies with advanceable, refundable tax credits: “You could begin a process, say over the next three to four years, one phases out and the other phases in.”

On the individual mandate: Could replace with automatic enrollment with an opt-out option: “As you phase out the mandate, you phase up enrollment, and boom, you got everybody in.”

On Medicaid expansion: Could tell the states: “Here’s that money, we’re going to allow you to combine it with those who are otherwise receiving support from a tax credit. And that way you make it seamless.”