The GOP has failed to put forward a full ObamaCare replacement plan, a significant political liability in an election year that stands to permanently cement the law.
Republicans this week made good on a five-year-old promise to pass a repeal bill through Congress and force a veto from President Obama.
Now they are going full throttle into a presidential election year with no clear-cut plan for replacing ObamaCare — and with a field of candidates led by the unpredictable Donald TrumpDonald TrumpChelsea Clinton attends Muslim solidarity rally in NYC Pentagon chief: 'I don’t have any issues with the press' Kasich: The media is 'an important part of democracy' MORE.
The party has held no markups, hearings or budget analysis on any replacement bills, and leaders have repeatedly refused to endorse any single provision beyond a broader promise to offer “patient-centered care.”
Top Republicans, such as Budget Committee Chairman Tom Price (R-Ga.), a doctor, is helping to spearhead the GOP’s effort in 2016, saying they are aware of the party’s vulnerability.
“Conservatives and Republicans have been accused of not having a plan,” Price told a roomful of conservatives at a panel hosted by the American Enterprise Institute last month. “When you have [a large] number of plans and you haven’t coalesced around a plan, you don’t have any plan."
“Until we rally around a single plan, I think we’ll continue to be subject to the demagoguery from the other side,” said Price, one of several Republicans who has put out legislative text of a plan.
Democratic presidential front-runner Hillary ClintonHillary Rodham ClintonChelsea Clinton attends Muslim solidarity rally in NYC Congressional Black Caucus expected to meet with Trump soon Why liberals should accept a conservative carbon tax plan MORE and her party, meanwhile, are signaling growing confidence that ObamaCare could become a winning issue at the polls.
They believe that the longer ObamaCare is in place, the tougher it will be to strip away people’s benefits.
The administration announced on Thursday that 11.3 million people had signed up for coverage this year. Millions more are getting coverage under the expansion of Medicaid and other provisions of the law.
“There is no current alternative that comes anywhere near covering 22 million people,” Drew Hammill, an aide to House Minority Leader Nancy Pelosi (D-Calif.), wrote in an email.
The lack of hearings and markups, he said, shows that “Republicans seem to not take it seriously.”
There are growing worries that if Republicans in Congress don’t come up with a plan, the GOP plan could be left to Trump, who has praised single-payer systems such as Canada’s national health system.
Trump has argued that his healthcare plan will be “something terrific” and that it will cover everyone.
"I am going to take care of everybody," Trump told Scott Pelley of CBS's "60 Minutes" in response to a question about universal health coverage. "I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now."
He also said he would negotiate with hospitals to take care of people but offered few specifics on how he'd pay for his plan.
"The government's gonna pay for it," he said. "But we're going to save so much money on the other side. But for the most part it's going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything."
Price’s 300-page bill, first released six years ago, calls for a combination of tax credits and regulatory reforms to bring down healthcare costs while also expanding access.
Republican leaders have had good reason to be reluctant about rolling out a comprehensive plan.
Any viable plan — which would have to be fully paid for — would likely require unpopular cuts to programs such as Medicare and deals with key industry groups, which would also draw ire.
Popular Republican ideas, like reducing the money spent on tax credits, would mean higher costs for lower- and middle-income families. While the average ObamaCare tax subsidy is $3,240 per year, the Price plan would reduce those credits to $3,000 for seniors and $1,200 for people under 35.
Even that approach, favored by 2016 candidates including Sen. Marco Rubio (R-Fla.), also has critics, who say it doesn’t go far enough in stripping away government intervention in healthcare.
“Obviously the devil’s strongly in the details about what that plan would actually be, and whether [House Speaker Paul RyanPaul RyanTrump’s feud with the press in the spotlight Republicans play clean up on Trump's foreign policy Graham: Ryan tax plan won’t get 10 votes in the Senate MORE] can unify his caucus around this,” said Josh Withrow, legislative affairs managers for the conservative group FreedomWorks.
He argues it’s understandable, though a problem, that the GOP hasn’t been able to rally around a specific plan.
“It was one of those things where they just thought it was too hard,” he said. “There are too many key points to a health care overhaul that are too contentious.”
Republicans say they are optimistic about the aggressive healthcare reform agenda already set by Ryan, a self-described policy wonk who has worked on his own replacement plan over the last year.
In the first week of 2016, Ryan made his commitment clear, delivering a repeal bill to the president’s desk for the first time.
“This is the closest that we've come to repealing ObamaCare,” Ryan declared to a packed room of his House colleagues Thursday as he ceremoniously prepared to send the bill to Obama’s desk while receiving hugs, handshakes and shoulder pats from his colleagues. “Hope is here, help is on the way.”
Ryan has refused to discuss the replacement, however. After the House vote on Wednesday, he said nothing more than: “Just wait.” When asked about the process on Thursday, Ryan again declined to share details or a timeline.
“The details of talking about how this alternative gets rolled out is not nearly as important as offering people a real, clear compelling choice in 2016,” Ryan told reporters.
ObamaCare replacement plans were a topic at Thursday’s meeting of Ryan’s eight-member advisory council, one member said, and it will also come up at the House GOP retreat next week, Ryan’s office said.
It will be a task for the Republican Study Committee and the House GOP Doctors Caucus, which have both already put out outlines of a healthcare bill.
“We plan to move pretty quickly,” said Rep. Bill Flores (R-Texas), who chairs the RSC and serves on Ryan’s leadership panel.
“Our goal is to get something out there that people can sink their teeth into,” Flores said, adding that he expects the RSC plan to be completed by late March.