WASHINGTON — Capitol Hill Republicans are taking their first steps toward repealing the Affordable Care Act this week, delivering on a key campaign promise but also raising questions about what comes next.
The Senate voted 51-48 early Thursday for a resolution that paves the way for repeal of the health care law, also known as Obamacare. The Senate plan uses a budget procedure known as reconciliation, which cannot be filibustered.
The House is expected to vote on the measure today.
The four senators from Nebraska and Iowa, all Republicans, supported the resolution. GOP lawmakers say Americans want the law scrapped.
“Now we are on the road to do that,” Sen. Deb Fischer of Nebraska said during her weekly conference call with reporters.
Fischer said there will be a stable transition period that protects families while lawmakers craft their replacement plan.
“My focus moving forward is to deliver the compassionate, hassle-free, personalized health care that Nebraskans deserve,” Fischer said.
Republicans haven’t settled on a specific plan to replace the law, although they have cited a host of possible approaches that include bolstering health savings accounts, allowing insurance to be sold and carried across state lines and overhauling the medical malpractice system.
Democrats have consistently challenged Republicans to ensure that any replacement will take care of the millions of Americans who have gained insurance as a result of the Affordable Care Act, which was signed into law in 2010.
Democrats have suggested that GOP proposals would actually allow many of those people to slip through the cracks.
Republican lawmakers are aware that they could face political fallout if repealing the Affordable Care Act costs people their health care coverage.
The American Action Network, a group aligned with House Republican leadership, is spending more than $1 million nationwide on an advertising campaign to tout the GOP repeal-and-replace effort. Targeted in part at districts expected to be battlegrounds in 2018, the ad will run for two weeks in the Omaha market.
The ad includes images of doctors treating patients and researchers hoisting test tubes, spliced with scenes of families walking on a beach, carrying a canoe and playing in a field at sunset.
The female narrator invites the viewer to imagine health insurance that, among other things, offers “more choices and better care, at lower costs.”
“House Republicans have a plan to get there without disrupting existing coverage, giving your family the health care it deserves,” the voiceover intones.
In fact, no such plan has been made public. But House members from Nebraska and Iowa are showing no signs of backing off the repeal effort in the meantime.
Rep. Jeff Fortenberry, R-Neb., said the idea of replacing the current law in one fell swoop is simply not realistic. Rather, he said, it’s a complicated question that should be approached in pieces.
“This has to be fair for everyone — no one gets left behind — but the current system is unsustainable and does not meet that test of fairness for millions of people who cannot afford what this has imposed on them,” Fortenberry said.
Rep. Don Bacon, R-Neb., campaigned last year in part on repealing the ACA. He narrowly defeated incumbent Democrat Brad Ashford in the Omaha area’s 2nd District. Bacon said recently that while the law has helped some people, more have been hurt. He said he will vote for repeal and then work on the replacement.
Sen. Ben Sasse has long been critical of fellow Republicans for simply denouncing the ACA without offering their own proposals.
Sasse reiterated his criticism that Republicans haven’t done enough on the issue. He said they need to find a way to address the problem that existed before the Affordable Care Act was passed: an increase in the number of uninsured Americans, which he said was driven at least in part by the nation’s increasingly transitory workforce.
“You still want health care financing that is diverse and nimble and competitive — you don’t want it run by the government,” Sasse said. “It’s a hard riddle to solve, and Republicans are a decade late to getting serious about the replace plan.”
He said that lawmakers will argue about the best avenues for replacement but that the only way to put force behind that debate is to repeal the current law. Absent that first step of repeal, he said, Washington would just ignore the issue.
“There are important fights to be had, but you’ve got to repeal to get to an urgency about those fights,” Sasse said.