President-elect Donald Trump said he plans to address the ACA in his first days in office, likely by taking executive action to annul certain parts of the law that the administration has the discretion to change, according to The Wall Street Journal. However, Republicans on Capitol Hill will need Democratic support to pass any ACA replacement plan.
With majorities in the House and the Senate, Republicans have anticipated being able to repeal the law with a special budget maneuver called reconciliation that would enable them to avoid a filibuster by Democrats in the Senate, according to the report. But to replace the ACA, they would need the support from eight Democrats and all 52 Republicans in the Senate to obtain the required 60 votes.
Here are five thoughts on the road through Congress to an ACA replacement, according to The Wall Street Journal.
1. An important factor that will influence Democratic support is whether Congress would repeal the ACA without having a replacement plan, or at least the votes for replacement. Congressional Republicans believe a transition period in which the ACA is phased out could pressure Democrats to support a replacement.
"Once it's repealed, you will have fewer people playing politics" on the healthcare law, House Majority Leader Kevin McCarthy, R-Calif., told The Wall Street Journal Tuesday.
2. Some Republicans and health policy advisers say Democrats might be attracted to negotiations if the talks include issues they care about, such as the rising prices of prescription drugs and high out-of-pocket healthcare costs, according to the report.
3. However, relying on bipartisan support for a replacement plan is risky, according to the report, as Democrats may not be as willing to shoulder responsibility for the second iteration of healthcare reform, written by Republicans.
"They haven't proposed anything that I could support so far," said Sen. Bob Casey, a Pennsylvania Democrat up for re-election in 2018, according to the report. "We'll see what happens."
4. Some senators, such as Maine's Angus King, an independent who caucuses with the Democrats, said he couldn't see how Republicans could reconcile their desire to preserve certain provisions of the ACA, such as guaranteeing coverage for individuals with preexisting conditions, whiling scrapping the individual mandate.
"If you don't have some kind of mandatory coverage or personal mandate, nobody will get health insurance until they're on the way to the hospital in the ambulance," said Sen. King, according to the report. "What I've heard so far doesn't hold together as a replacement plan."
5. However, some Democrats have expressed more openness to Republicans' ideas. "I would like to see what they propose," said Sen. Joe Manchin of West Virginia, according to the report. "I'm amicable to anything if it makes sense. [But] if I can't go home and explain it, I can't vote for it."