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Five key decisions for the GOP on health care

Five key decisions for the GOP on health care
© Greg Nash

Republicans have repealed ObamaCare’s individual insurance mandate, but they still have a number of decisions to make on health care in the coming year.

Even without the unpopular mandate, the health-care law is still largely in effect, with nearly 9 million people enrolled in private plans for 2018.

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And beyond ObamaCare, Republicans could seek action on entitlement reform and drug pricing in 2018.

Here are five things to watch out for.

 

Will Republicans try again to repeal ObamaCare? 

After Republicans failed to act on a seven-year promise to repeal and replace ObamaCare, they assured voters they would return to the issue after passing tax reform.

But now that the tax law is on the books, it’s far from certain that Republicans will make another run at the Affordable Care Act. With the GOP’s Senate majority set to shrink in January, repeal might be off the table for now.

"Well, we obviously were unable to completely repeal and replace with a 52-48 Senate," Senate Majority Leader Mitch McConnel (R-Ky.) told NPR on Thursday.

"We'll have to take a look at what that looks like with a 51-49 Senate. But I think we'll probably move on to other issues," he said.

But McConnell could face pressure from more conservative Senate Republicans — and possibly from the House — to revisit health care, no matter how steep the challenge.

"To those who believe — including Senate Republican leadership — that in 2018 there will not be another effort to Repeal and Replace Obamacare — well you are sadly mistaken," Sen. Lindsay Graham (R-S.C.), author of the most recent repeal bill, tweeted last week.  

 

Will Congress act to stabilize ObamaCare? 

Sens. Susan CollinsSusan Margaret CollinsDems vow swift action on gun reform next year Collins reiterates call for legislation to protect Mueller investigation GOP nerves on edge after Sinema takes lead over McSally MORE (R-Maine) and Lamar AlexanderAndrew (Lamar) Lamar AlexanderCongress needs to wake up to nuclear security threat Blackburn keeps Tennessee seat in GOP hands  Overnight Health Care — Presented by Purdue Pharma — Judge urges insurers to drop challenge over non-ObamaCare plans | Azar vows to push ahead with drug pricing proposal | No increase for ObamaCare outreach budget MORE (R-Tenn.) have been pushing for a vote on two bipartisan bills to stabilize ObamaCare’s insurance markets, but those efforts were pushed off until next year. 

McConnell assured Collins the bills would be attached to a “must-pass” bill by the end of 2017, but that changed as Republicans scrambled to avoid a government shutdown. 

Now Senate Republicans are looking to attach the ObamaCare bills to the long-term spending bill that is expected to come up for a vote in January.

But passing the ObamaCare bills is far from certain, with House Republicans demanding the inclusion of Hyde Amendment language to prevent any federal money from going to plans that cover abortions. 

House Republicans have also been critical of the overall substance of the bills, arguing they’re a “bail out” of a failing law.

It’s unclear whether House Republicans would support a spending bill that contains the ObamaCare bills, but many have said they definitely won’t if the abortion language isn’t included.

Sen. Mike RoundsMarion (Mike) Michael RoundsOn The Money: Deficit hits six-year high of 9 billion | Yellen says Trump attacks threaten Fed | Affordable housing set for spotlight in 2020 race Lawmakers, Wall Street shrug off Trump's escalating Fed attacks GOP shrugs off dire study warning of global warming MORE (R-S.D.) said Senate Republicans are looking at ways to resolve the issue, and Alexander said he’s optimistic about the bills passing in January. 

“We have the president’s renewed interest, more interest from the House, Sen. McConnell has renewed his commitment to schedule it and support it, so I think it’s just a matter of when we come back, putting out ideas together and finding a way to get it done,” Alexander told reporters. 

 

Will Republicans try to tackle entitlements? 

Speaker Paul RyanPaul Davis RyanJordan on leadership loss: 'We knew it was an uphill fight' McCarthy defeats Jordan for minority leader in 159-to-43 vote The Hill's 12:30 Report — Sponsored by Delta Air Lines — Leadership elections in Congress | Freshman lawmakers arrive | Trump argues he can restrict reporter access MORE (R-Wis.) has said Republicans should move to entitlement reform next year, citing the need to address the nation’s red ink.

“We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” Ryan told the Ross Kaminsky radio talk show earlier this month. 

While there’s broad support in the GOP for taking up welfare reform, changes to entitlement programs such as Medicare and Social Security could be a tough sell.

McConnell has noted that a slim Republican majority in the Senate could put broader entitlement reform out of reach. 

"The sensitivity of entitlements is such that you almost have to have a bipartisan agreement in order to achieve a result," McConnell said at a press conference Friday

"The only time we’ve been able to do that is on a bipartisan basis, and it was a long time ago,” he said. 

Entitlement cuts could also be politically dangerous for Republicans leading into the 2018 midterm elections. 

 

Will Trump try to help ObamaCare? 

Democrats have accused the Trump administration of trying to sabotage ObamaCare by slashing the law’s advertising and outreach budget and cutting the time frame for open enrollment in half.  

But those actions seemed to have a minimal effect on enrollment. The administration said 8.8 million people signed up for coverage in the exchanges this year, which is only a slight drop from the 9.2 million people who signed up last year.  

Democrats say these numbers show the resiliency of the law.

“[The] enrollment numbers make clear that the American people want access to high quality, affordable health insurance coverage, and they want Congress and the Administration to stop playing games with our health care system,” Rep. Frank Pallone Jr.Frank Joseph PalloneOn The Money: Trump, Senate leaders to huddle on border wall funding | Fed bank regulator walks tightrope on Dodd-Frank | Koch-backed groups blast incentives for corporations after Amazon deal Overnight Health Care — Presented by The Partnership for Safe Medicines — Dem vows Medicare drug price negotiations will be priority | ObamaCare enrollment down compared to last year | HHS declares health emergency in California Incoming Dem chairman: Medicare negotiating drug prices is a priority MORE (D-N.Y.), ranking member of the House Energy and Commerce Committee, said in a statement.

Trump indicated on Tuesday that his administration still intends on repealing and replacing ObamaCare, however. 

“Based on the fact that the very unfair and unpopular individual mandate has been terminated as part of our tax cut bill, which essentially repeals (over time) ObamaCare, the Democrats & Republicans will eventually come together and develop a great new HealthCare plan!” he tweeted Tuesday.

 

Will Trump take action on drug prices? 

Trump came out swinging against drug companies when he took office in January, declaring that the industry is getting away with murder, but so far has taken little action on drug prices. 

The administration has been preparing an executive order aimed at lowering drug prices since the summer, but critics argue the order would be friendly to drug companies. 

Trump has also abandoned campaign promises to allow Medicare to negotiate drug prices and expand importation of cheaper drugs from other countries. 

However, Alex Azar, a former drug executive and Trump’s nominee to lead the Department of Health and Human Services, has said that addressing drug prices will be one of his top priorities if he’s confirmed.  

“I believe I can hit the ground running to work with you and others to identify solutions here,” Azar told senators during his confirmation hearing.