GOP leaders look to early health care bill amid uncertainty about replacement

FILE - In this Jan. 4, 2017 file photo, Senate Majority Leader Mitch McConnell of Ky. pauses during a news conference on Capitol Hill in Washington. The Republican-led Senate is poised to take a step forward on dismantling President Barack Obama’s health care law despite anxiety among some GOP senators that they still haven’t come up with an alternative. (AP Photo/Cliff Owen, File)

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Under mounting pressure from Donald J. Trump and rank-and-file Republicans, congressional leaders are talking increasingly about chiseling an early bill that dismantles President Barack Obama's health care law and begins to supplant it with their own vision of how the nation's $3 trillion-a-year medical system should work.

Yet even as Republicans said they will pursue their paramount 2017 goal aggressively, leaders left plenty of wiggle room Thursday about exactly what they will do. And that uncertainty is causing angst for many consumers and health care providers worried about how some medical services and health care coverage will be funded if the Affordable Care Act is repealed.

"Repealing and replacing Obamacare is a big challenge," Senate Majority Leader Mitch McConnell conceded after the Senate voted early Thursday for a budget reconciliation measure to clear the way for Congressional repeal of the so-called Obamacare plan. "It isn't going to be easy."

A statewide survey last week of 840 Tennesseans found that 57 percent of respondents want Congress "to keep what works in the Affordable Care Act and fix what doesn't," compared with only 37 percent of Tennesseans who said they want the so-called Obamacare law repealed and for leaders to start over with a new healthcare law. The random survey conducted by Public Policy Polling for the Alliance for Healthcare Security found majority support for many Affordable Care Act features, including protections against denying coverage for those with pre-existing conditions, paying for routine checkups and providing tax subsidies for low-income workers to buy insurance.

Nearly two thirds of the Tennesseans surveyed said they are somewhat or very concerned about repealing Obamacare without anything to replace it.

"Even in a red state like Tennessee, there seems to be an overwhelming sentiment that folks don't want to go back to the days when insurers could deny coverage for pre-existing conditions or having so many people without health insurance," said Jim Williams, a polling analyst for Public Policy Polling.

Tennessee's hospitals worry that if the Affordable Care Act is repealed and other funding sources are not in place as a substitute that more medical bills won't be paid and some rural hospitals might have to close.

"Tennessee's rural hospitals in particular, along with those hospitals with high amounts of uncompensated care, are in dire financial straits and rely heavily on revenue as a result of increased health coverage through the ACA," said Craig Becker, president of the Tennessee Hospital Association. "Losing those additional funds would be devastating."

Both of Tennessee's U.S. senators have voiced caution about just repealing the entire Affordable Care Act without a replacement for many of its most popular features.

U.S. Sen. Lamar Alexander, chairman of the Senate health committee, has urged a three-part plan to repeal and replace Obamacare over the next several weeks or months. U.S. Sen. Bob Corker, a member of the Senate Banking Committee, was among a handful of Republican senators who backed an amendment to delay the budget reconciliation approval until March to give more time to work out a replacement plan for Obamacare.

But both Corker and Alexander voted early Thursday in a procedural vote to repeal Obamacare after receiving assurances that a replacement measure will be in place soon. Both have condemned Obama's signature health care plan as too expensive and burdensome for both businesses and consumers.

"The Affordable Care Act has led to high premiums, rising out-of-pocket costs, and reduced choice across the Volunteer State, and I am pleased Congress has initiated the repeal and replace process," Corker said before voting with 50 other Republicans for a budget reconciliation measure Thursday. "We need a health care system that works for the American people, and I am encouraged that the debate has shifted in recent weeks from 'repeal only' to 'repeal and replace' in a thoughtful and deliberative manner."

Trump said Wednesday that Congress needs to repeal and replace Obamacare, which he called "a total disaster" because of its cost to both consumers and businesses.

The president-elect said his designated cabinet choice for Health and Human Services, Georgia Rep. Tom Price, will quickly develop a replacement health care plan along with GOP congressional leaders after he is confirmed.

The House of Representatives is expected to vote today to repeal the Affordable Care Act. Trump and Republicans in Congress have said they will offer a better program to cover uninsured Americans. But they have yet to detail the specifics of such a plan, including how it would work and how it would be paid for.

Asked how quickly lawmakers could send Trump a bill, No. 2 Senate Republican leader John Cornyn of Texas said, "The most important thing is when do you get 218 votes in the House and 51 votes in the Senate," the majorities needed for passage.

In Chattanooga, a group of nearly two dozen supporters of the Affordable Care Act met with representatives of Corker and Alexander this week to urge them to make sure there is an effective health care replacement plan in place before repealing the existing law. The supporters said that Obamacare has helped each of them to get medical insurance - and some claim the law has saved the lives of family members.

Pat Combs, the mother of a 26-year-old daughter with a history of endometriosis who was diagnosed with bipolar disorder, said Obamacare allowed her daughter to be on her plan and continue to get the health care coverage she needs. The Affordable Care Act extended health care benefits to the dependents of those with insurance up to age 26.

"There is no way she could have afforded the drugs without insurance," Combs said of her daughter. "Obamacare saved her life and she will be forever grateful. If she did not have coverage, just one of her medications would cost almost $300 a month, and now she pays just $25 a month."

Melody Shekari, who says she has long dreamed of starting her own business, praised the Affordable Care Act for providing assistance and better after-tax rates for individuals starting their careers on their own, not covered by an employer plan.

"This instability [of not knowing the future of Obamacare] means that I will have to put aside my plans to start a business or work with a startup company and find a job that can cover my health insurance needs affordably," said Shekari, who ran last year as a Democrat in Tennessee's Third District congressional race.

Contact Dave Flessner at [email protected] or 423-757-6340.