For Senate hopefuls, Obamacare replacement still up in air

Jan. 07--Like most of his Republican colleagues, state Sen. Greg Reed, R-Jasper, ran for re-election in 2014 on a promise to "push back" against the Affordable Care Act.

Now that Obamacare is likely on its way to repeal -- and Reed possibly on his way to the U.S. Senate -- Reed faces a tougher task: Figuring out what will replace the health-care law.

"There's a world of difference between campaigning and actual governance," Reed said.

Reed, like a lot of Alabama politicians, lives in a state of limbo as Donald Trump's presidency is about to begin. Trump has named U.S. Sen. Jeff Sessions of Alabama as his attorney general. There are 20 possible candidates to replace him. Reed is one of the candidates, though Gov. Robert Bentley, who'll appoint the replacement, has said little about who he intends to choose.

Whoever ultimately takes Sessions' seat will likely cast a crucial vote on what comes after Obamacare. Republicans in Congress are setting the stage for a repeal of the Affordable Care Act, with an expiration date down the road and a plan to craft a replacement before the law expires.

The Star asked several of the candidates for their thoughts on what should come after Obamacare. All acknowledged that there are significant unknowns. The biggest: what will happen to people who get their health insurance through the federal healthcare exchange.

"I can't tell you what it's going to look like," said state Sen. Del Marsh, R-Anniston, another candidate for the Senate slot.

Marsh said he expects any Obamacare replacement to include looser restrictions on health insurance companies selling insurance across state lines -- something he says will drive down health insurance costs.

"You've got to allow the free market to work," he said.

Other candidates for the Senate seat said they, too, support more insurance sales across state lines, as has President-elect Trump.

Reed, who's a health-industry executive in his day job and one of the Alabama Legislature's go-to guys for health policy, thinks that could be one of the most difficult changes to pass.

Competition would drive down insurance costs, Reed said, and would even probably drive down the prices doctors charge to insurance companies. For that very reason, Reed said, the health-care industry would have little reason to support it.

"You wind up having a reduction in the entire health-care economy, though we would have a lower-cost health system," Reed said.

None of the candidates who spoke to The Star explicitly supported keeping the individual mandate -- the portion of Obamacare that requires people to buy insurance. Health policy experts have said the mandate -- which brings in younger and healthier customers -- is needed to keep costs down if pre-existing conditions are covered.

Still, some hinted that a mandate in some form might still be on the table.

"Just look at the Rubio plan," said state Sen. Cam Ward, R-Alabaster, another candidate for the Senate seat. "There's some form of mandate there."

During the presidential campaign, candidate Sen. Marco Rubio, R-Fla., introduced a proposal to give people an "advanceable, refundable tax credit" to buy health insurance. People who don't use the tax credit would, presumably, have to pay the same amount in federal taxes. The plan ignited a debate among conservatives about whether the plan was the same as Obamacare's mandate, which charges tax penalty to people who don't buy insurance.

While Trump won election on a promise of repealing Obamacare sooner rather than later, Congress may yet get cold feet about the repeal-then-replace plan. A Kaiser Health Tracking poll last week found that only 20 percent of Americans want to repeal the law and find a replacement later. Another 38 percent wanted a repeal only after a replacement plan is announced.

Forty-seven percent of respondents opposed repeal altogether.

Senate candidates last week seemed aware that Republicans are likely to own the political fallout if repeal-and-replace goes wrong.

"This is not going to be an easy fix," Ward said.

Ward and Reed both said a piece-by-piece repeal might be the end result. Another candidate, state Sen. Arthur Orr, R-Decatur, said it will be nearly impossible to make changes without some concessions to Democrats, because of Senate rules that require more than a majority vote for many bills.

"If you're truly going to replace it, you're going to need 60 votes, and that's going to require lots of compromises," Orr said.

Still, some candidates think a quick repeal is the first step.

"If you're not willing to repeal it, you're not going to get to the place where you can craft a deal to replace it," Marsh said.

Capitol & statewide reporter Tim Lockette: 256-294-4193. On Twitter @TLockette_Star.

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