President Barack Obama met behind closed doors this morning with congressional Democrats to map out a strategy to defend the Affordable Care Act and other health-care policies – the very day Republicans are beginning debate on how to get rid of the sweeping 2010 health-care law.
Obama’s rare visit to Capitol Hill, less than three weeks before Donald Trump assumes the presidency, is part of his administration’s final push to hold onto its achievements before handing over the reins of power in Washington. Next week, Obama will deliver his farewell address in his adopted hometown of Chicago.
The president arrived at the Capitol at about 9:20 a.m. Accompanied by Senate Democratic leader Charles Schumer of New York, House Minority Leader Nancy Pelosi, D-Calif., and Rep. Frederica Wilson, D-Fla., Obama took no questions from reporters.
Within 10 minutes of Obama’s arrival, Vice President-elect Mike Pence joined House Republicans in the Capitol basement to discuss the incoming administration’s plans to reverse not just the health care law but a slew of other executive actions.
Afterward, Pence told reporters that he and Trump would pursue a “two-track approach” to chip away at the ACA through a combination of executive powers and legislation. Trump is “working on a series of executive orders that will enable that orderly transition to take place,” Pence said, and is eyeing other policies that can be reversed.
While Pence did not identify other policy targets, Republicans from Western states urged him Wednesday to undo some of the public lands protections Obama has created through the 1906 Antiquities Act. Other executive actions, including those providing new safeguards for lesbian, gay, bisexual and transgender Americans and curbing greenhouse gas emissions linked to climate change, could also come under fire.
Trump, for his part, took to Twitter on Wednesday morning to urge Republicans to “be careful in that the Dems own the failed ObamaCare disaster.” In a dig at Schumer and his allies, Trump added: “Don’t let the Schumer clowns out of this Web.”
Less than half an hour after Trump’s social media messages, Schumer tweeted: “Republicans should stop clowning around with America’s health care. Don’t #MakeAmericaSickAgain.”
Speaking to reporters Tuesday, White House press secretary Josh Earnest said that “the president is deeply concerned about the impact” of Republicans’ “stated objective” to repeal and replace the signature health-care law, which has extended insurance to more than 20 million Americans.
Democrats are “interested in looking out for working people in this country,” Earnest said, adding that “the president’s message will be to encourage them in that fight and to offer his own insight about the most effective way to engage in that fight.”
Pence, who was greeted by applause as he entered the House GOP meeting with Reince Priebus, Kelly Anne Conway and several other future White House aides, made clear that Trump intended to embark on an aggressive campaign to reverse executive actions made by Obama starting on the first day of his presidency.
But members who attended the session said Pence offered few specifics on the pace or policies these repeal efforts.
“They didn’t enumerate a list, just that which came by the pen can die by the pen,” said Rep. Mark Sanford, R-S.C.
Several members said they expect Pence will be the main point of contact between Congress and the White House and will spend a significant amount of time on Capitol Hill. Pence told members that he hopes to have an office on the House side of the Capitol in addition to the work space provided to him as president of the Senate.
The first bill Republicans introduced in the new Senate that began on Tuesday was budget legislation with instructions for House and Senate committees to begin repealing the Affordable Care Act. The bare-bones spending outline gives members of four committees – Ways and Means and Energy and Commerce in the House; and Finance and Health, Education, Labor and Pensions in the Senate – until Jan. 27 to produce bills that each would save $1 billion over a decade by slashing elements of the heath-care law.
“Americans face skyrocketing premiums and soaring deductibles,” Senate Budget Committee Chairman Mike Enzi, R-Wyo., said in a statement. “Today, we take the first steps to repair the nation’s broken health-care system, removing Washington from the equation and putting control back where it belongs: with patients, their families and their doctors.”
Senate rules allow budget resolutions to pass by a simple majority – a maneuver that guarantees that the chamber’s Democratic minority will not have enough votes for a filibuster to block the eventual repeal bill. Only changes related to taxes, spending or the long-term federal budget are eligible for the simple-majority treatment, however, restricting the extent to which Republicans can rescind the law.
Other parts of the law, such as the structure of the insurance marketplaces, would likely require a veto-proof margin of 60 votes in the Senate, a trickier task because the new Senate contains 52 Republicans.
Since its passage by Congress in the spring of 2010 – entirely with Democratic votes – the ACA has spurred the most significant changes to U.S. health policy since the creation of Medicare and Medicaid during the Great Society legislation of the 1960s. It also has faced sustained opposition by its Republican foes, leading to two Supreme Court cases and a lawsuit over cost-sharing subsidies that is now before the U.S. Court of Appeals for the District of Columbia Circuit. The arrival of a GOP president sharing their antipathy for the law now gives congressional Republicans their long-awaited chance to demolish it.
The ACA is best known for having expanded insurance coverage, starting in 2014, in two ways: new marketplaces selling private health plans to Americans who do not have access to affordable health benefits through a job, and an expansion of Medicaid in about three-fifths of the states. The marketplaces got off to a shaky start because of computer dysfunction with HealthCare.gov, the federal enrollment website.
Three years later, the U.S. Census survey reported that the nation’s uninsured rate had declined to 9.1 percent, with most of a recent decrease coming from people who bought insurance on their own and more who had joined Medicaid.
The law has aspects that reach deep into the health-care system. It has eliminated the ability of health insurers to place yearly or lifetime limits on consumers’ coverage and deny insurance on the basis of preexisting medical conditions. It has led to more preventive care for older Americans through Medicare. It has created an “innovation center” within the Department of Health and Human Services that has been trying to slow health-care expenditures, in part by nudging doctors and hospitals away from fee-for-service medicine and toward payment methods with incentives to lower costs while emphasizing quality. And it has led HHS to define a set of benefits that must be included by all health plans sold on the ACA marketplaces.
After the meeting with the president, Sen. Ron Wyden, R-Ore., an author of parts of the bill, sidestepped a question about whether Democrats would work with Republicans on language for a replacement.
“As of now, what we’re looking at is breaking a pledge to the American people,” he said. “They were told for months and months that repeal and replace were intertwined.”
But Wyden didn’t say that Democrats could defeat the budget reconciliation bill outright.
“They have the votes,” he said. “There’s never been any question about that. If you’re going to use a budget scheme, they’ve got the votes.”
The president’s appearance on the Hill is part of a broader effort by his administration to use its final weeks in power to defend a central element of Obama’s domestic legacy.
On Jan. 9, HHS Secretary Sylvia Mathews Burwell is scheduled to deliver her first speech at the National Press Club, according to an administration official who spoke on condition of anonymity about the not-yet-announced event. The official said that Burwell will appear with a few Americans who have benefited from the ACA in various ways and who would be harmed if it were dismantled.
Meanwhile, HHS officials have been trying to use to their messaging advantage about the fact that the change in administrations will take place while the fourth year’s enrollment period for ACA health plans is still underway. In recent weeks, HHS has been releasing HealthCare.gov enrollment figures, pointing out that the number of people signing up for 2017 coverage in the 39 states relying on the federal exchange website is running ahead of last year.
In advance of Wednesday’s action on Capitol Hill, major groups that have supported the ACA issued warnings about the effects of its repeal.
Debra Ness, president of the National Partnership for Women & Families, said in a statement that repealing the law would reverse what amounts to “the greatest advance for women’s health in a generation; among other provisions, it provides access to affordable birth control and coverage for maternity services, and it ends the practice of charging women higher premiums simply because of their gender.”
Republicans – including Pence, a longtime abortion opponent – have vowed to cut off all funding for Planned Parenthood now that there is a president willing to enact such a ban. Barring Medicaid from reimbursing Planned Parenthood for providing services for poor women, Ness said, prevents these “low-income patients from accessing essential health care and would have a devastating impact on public health.”
Meanwhile, the American Medical Association, the nation’s largest physicians’ lobby, dispatched a letter to House and Senate leaders in both parties that contains a more nuanced expression of its goals. The letter, from AMA chief executive James L. Madara, says that the organization backed the law because “it was a significant improvement on the status quo at that time” and urged lawmakers to hold off on any repeal until they have decided upon their own health-policy ideas.
“Before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies,” it said.
But the letter adds, “We also recognize that the ACA is imperfect and there a number of issues that need to be addressed. As such, we welcome proposals, consistent with the policies of our House of Delegates, to make coverage more affordable, provide greater choice, and increase the number of those insured.”
The new drive to unwind the health-care law will take time. Senate leaders must also allow Democrats to offer a nearly unlimited number of amendments before a final budget vote. Democrats plan to use the process, known as a “vote-a-rama,” to offer a long string of potentially toxic amendments that could make it difficult for Republicans to vote for the final legislation, Democratic leadership aides said.
(c) 2017, The Washington Post · Juliet Eilperin, Amy Goldstein