WASHINGTON — Republicans in Congress say that while they plan to repeal Obamacare quickly next year, it will be up to three years before the repeal actually takes effect.
Once Donald Trump becomes president, Republicans say they can immediately repeal much of the Affordable Care Act by using the reconciliation process to avoid a Democrat filibuster. But they plan to enact as much as a two-to-three year delay before the repeal actually takes effect.
This will give them time to craft replacement legislation and try to win over some Democrats to reach a bipartisan consensus on that plan. While much of the Affordable Care Act can be repealed with a simple majority through reconciliation, at least 60 senators will likely need to vote for a full replacement.
“Obviously there’s got to be a transition. And we’ve got to make sure the people who had trouble getting insurance will be covered in the transition," Georgia Sen. David Purdue said.
This strategy allows Republicans to have it both ways. During the campaign, Trump promised that "on day one" of his administration he would call for Congress to "immediately" repeal Obamacare.
By voting to repeal Obamacare right away, Republicans can say they've honored that promise. But by delaying the implementation, they can buy time to work out their own plan and prevent millions of people from losing their insurance before a replacement is in place.
Utah Sen. Orrin Hatch said he does not believe voters will see the plan as a broken campaign promise.
"They’re going to have the same benefits from Obamacare until we can straighten it out and get the healthcare system done right. So I don’t see any reason for anybody to be too upset about it,” he said.
But there are questions about what this will do to the individual insurance market in the meantime. Larry Levitt, a senior advisor for the Kaiser Family Foundation, said that a years-long limbo period would cause "a significant risk of chaos" in the individual insurance market. Insurers too are worried about instability in the marketplace.
Levitt said that the market is already fragile with many insurers exiting, while others are sticking around based on the promise of future profit. He said that those who are staying put for now are unlikely to stick around for a couple more years of uncertainty.
"If a repeal bill follows the pattern of the previous one – which repealed the individual mandate immediately but kept in place the requirement that insurers provide coverage to people with pre-existing conditions – it’s likely insurers would run, not walk towards the exits," said Levitt.
Republicans have to figure out this balance between spiking the unpopular parts of the Affordable Care Act, while preserving popular sections banning insurers from denying healthcare to sick people.
They also need to decide on issues that have split their party, such as expanding Medicaid. Georgia Rep. Tom Price has long opposed the expansion and was just will be nominated by Trump to be his secretary of Health and Human Services. (Price will have to be confirmed by the Senate before taking over the agency).
But several Republicans represent states that rely on those same subsidies.
“I’m from a state that has an expanded Medicaid population I’m very concerned about," said West Virginia Sen. Shelley Moore Capito. "I don’t want to throw them off into the cold... there’s over 200,000 people in my state [relying on Medicaid subsidies]. So we need a transition."