Top House Republicans unveiled a rough sketch of a massive health care overhaul to rank-and-file lawmakers Thursday, but a lack of detail, cost estimates and GOP unity left unresolved the problem that's plagued them for years: What's the party's plan and can Congress pass it?
At a closed-door meeting in the Capitol basement, House Speaker Paul Ryan, R-Wis., and other party leaders described a broad vision for voiding much of President Barack Obama's 2010 statute and replacing it with conservative policies. It features a revamped Medicaid program for the poor, tax breaks to help people pay doctors' bills and federally subsidized state pools to assist those with costly medical conditions in buying insurance.
Lawmakers called the ideas options, and many were controversial. One being pushed by Ryan and other leaders would replace the tax increases in Obama's law with new levies on the value of some employer-provided health plans — a political no-fly zone for Republicans averse to tax boosts.
"You have to legislate with a sense of political reality," said Rep. Tom Cole, R-Okla., who said backing that proposal "would set up an ad against you from multiple directions" during upcoming elections.
The scant health care progress mirrors a lack of movement on other issues in a capital run by the GOP. No proposals have surfaced to pursue President Donald Trump's campaign promises to build a border wall with Mexico or buttress the nation's infrastructure, and Republicans have yet to coalesce around another priority, revamping the nation's tax code.
Senate Republicans have criticized a House GOP plan to change how corporations are taxed. Trump has said he will release his own proposal in the coming weeks, but nothing had been produced, drawing mockery from Democrats.
"At some point we need to move from imaginary made-up plans to things that you can read on paper," said Sen. Mark Warner, D-Va.
The health care outline was aimed at giving Republicans something to exhibit during next week's congressional recess, at a time of boisterous town hall meetings packed with supporters of Obama's law. Ryan told reporters that Republicans would introduce legislation voiding and replacing Obama's statute after Congress returns in late February, but offered no specifics.
Many Republicans took an upbeat tone after Thursday's meeting, with Rep. Peter King, R-N.Y., saying, "We're only 27 days into the new administration, so we have time."
But they have repeatedly failed for seven years to rally behind a substitute plan, and there are no guarantees of success in replacing a law that has extended coverage to 20 million Americans.
"We're not going to get out of this overnight," Rep. Bill Huizenga, R-Mich., said of the overall effort.
There are sure clashes ahead this time over crucial specifics that could jeopardize the entire effort. And lawmakers said they were awaiting official cost estimates from the nonpartisan Congressional Budget Office, which could ignite other battles if the price tag is disconcertingly high.
Obama's law levied $1.1 trillion in taxes over a decade to finance its expanded coverage to millions. GOP leaders said some or all of those taxes could be repealed, with the revenue replaced by a new tax on health care that employees receive at work.
Two people familiar with the proposal said individuals would pay taxes on the value of such coverage above $12,000, and above $30,000 for families. Republicans would not confirm those amounts, though House Ways and Means Committee Chairman Kevin Brady, R-Texas, told reporters "the vast, vast majority of Americans" would be unaffected.
According to documents distributed to members and obtained by The Associated Press, the expansion of Medicaid to millions of additional poorer people — almost entirely financed by federal taxpayers — would be phased out. In a compromise aimed at resolving a bitter dispute, extra Medicaid money would flow to the 31 states that accepted that expansion and the 19 that didn't, though it would end "after a certain date" left unspecified.
After that, states would get far more discretion to decide who would be covered by Medicaid. They'd also decide whether to receive federal Medicaid funds based on the fluctuating numbers of the program's beneficiaries or a set annual amount.
The tax penalties Obama's law levies on people who don't buy insurance would be abolished, as would federal subsidies for most people buying coverage on the online exchanges the statute established. They would be replaced by tax credits for people who don't have job- or government-provided health coverage and tax-advantaged health savings accounts. Republicans said decisions on amounts have not been made.