Repeal And Replace Losing Steam But Not Derailed

WASHINGTON - Congress is ready to start major work this week on dismantling the Affordable Care Act, but conservatives are fuming over lost momentum that they fear could doom a repeal.

Lawmakers missed a nonbinding deadline to deliver details of a repeal plan Friday, and left a Republican retreat in Philadelphia without reaching consensus on a replacement package that an increasing number of Republicans want to see agreed to before the 2010 law is taken apart.

Complicating the effort, Congress is struggling to find its footing with an unpredictable administration whose actions in only one week have distracted from what lawmakers thought was the top item on the Republican agenda.

Some conservatives worry that delay could be costly, perhaps even fatal, sapping lawmakers' drive to repeal and sidelining the effort in favor of other priorities, such as keeping the federal government running.

"Right now you are seeing the question of replace stopping the momentum of repeal," said James Wallner, a former Senate aide and group vice president for research at the conservative Heritage Foundation. "Before you know it, you are into the late summer or fall because you have to do stuff like funding the government, and you haven't done (repeal) yet. You can see very quickly how you end up in a place where you're just trying to shore up the existing system."

But former House Speaker Newt Gingrich, an on-again, off-again adviser to the president, insisted that Congress will not get sidetracked with Trump at the top.

"It is inevitable that it will be replaced," Gingrich said of the health care law.

"There is a very deep awareness, which the president has emphasized, that you cannot leave 23 million people worried about their health insurance," Gingrich said. "You can't just repeal with a vacuum and you go from the Democrats owning it to us owning it. Why should we rush in to own their problem?"

Scott Jennings, political director for former President George W. Bush, said Sunday that Republicans can't afford to put health care "on the back burner," though it may get less news coverage because of what he called "hysteria" over the vetting order as thousands of Americans protest Trump's unrelated order to bar refugees from seven Muslim-majority countries from entering the U.S.

House Speaker Paul Ryan has outlined an agenda that calls for delivering repeal and replace legislation to Trump's desk by late March or early April. The measure that is currently funding the government expires at the end of April and will be a priority for lawmakers. So will repeal, Ryan said Friday.

"We have to move quickly but not at the expense of not getting it right," Ryan said.

House committees are expected to take votes within the next two weeks on draft legislation to repeal the law.

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But finding compromise legislation to replace it remains a stumbling block, said Sally Pipes, president of the Pacific Research Institute and a former health care advisor to Rudy Giuliani's presidential campaign. Several members of Congress have plans. Ryan last year detailed how he would replace the 2010 law that required nearly everyone to obtain health insurance.

"How can they get anything together when they have too many plans and everyone wants to take credit?" Pipes said. "Politicians when they're elected, they need to do the tough things, right away, upfront, otherwise it doesn't happen."

Trump has promised a health care plan that will offer "insurance for everybody," but few details. Lawmakers had hoped for more clarity at the legislative retreat in Philadelphia, but he did not stay for questions.

Many hope that once confirmed, Rep. Tom Price, R-Ga., Trump's nominee for health and human services secretary, will help shape legislation and identify action that he can take to help dismantle the law. The Senate Finance Committee is scheduled Tuesday to vote on Price's nomination, although Democrats are now under pressure to slow confirmations after Trump's latest round of executive orders.

Price offered lawmakers little guidance last week at his confirmation hearing, saying he would want to make certain "that every single American has access to affordable coverage."

Lawmakers at the retreat predicted that the legislation would pass in sections: "You will not see a massive anti-Obamacare thing jammed through," said Rep. Ted Budd, R-N.C.

"We're probably going to be working into the night and over a couple of weekends to get it done," said Rep. Mike Bost, R-Ill. "But we'll get it done."

Lawmakers are using a budget resolution that called for a repeal plan to be delivered to the White House by Jan. 27, but that deadline was widely viewed as a moving target.

The budget resolution allows Congress only to pull back the parts of the law that deal with spending or taxes. So further repeal and replacement would need another measure - one that could require 60 votes in the Senate, including from Democrats.

That could further fracture Republicans. Two Senate Republicans introduced legislation last week with hopes of securing Democratic support, but it would not repeal the taxes in the 2010 law that pay for many of its provisions.

The plan offered by Sens. Bill Cassidy, R-La., and Susan Collins, R-Maine, also allows states that want to keep the Affordable Care Act to do so.

Keeping the taxes is unlikely to appeal to many Republicans, Sen. Rand Paul, R-Ky., said as he announced his proposal. His Obamacare Replacement Act would eliminate the requirement that most Americans purchase insurance or pay a fine, and authorize tax credits for individuals and families that contribute to health savings accounts.

And telling states "if you like Obamacare you can keep it is not a rallying cry that Republicans across the country are going to rally to," Paul said.

Allowing states like California and New York to keep Affordable Care Act coverage through federal funding would require states that don't want the law "to pay for New York and California's Obamacare," Paul said.

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(Anita Kumar and Curtis Tate contributed to this report.)