Groups demanding ‘full repeal’ of Obamacare could derail health care rollback

WASHINGTON – An array of conservative lawmakers, organizations and activists are demanding a swifter and more aggressive remake of the Affordable Care Act than many Republicans are comfortable with, raising questions about whether President Donald Trump and the GOP have the votes to meet their promise to repeal and replace the health-care law.

Three conservative senators known for bucking GOP leadership during Barack Obama’s presidency – Ted Cruz of Texas, Rand Paul of Kentucky and Mike Lee of Utah – are raising the possibility of doing the same under Trump.

And outside the halls of Congress, three prominent groups – FreedomWorks, Americans for Prosperity and Heritage Action for America – plan to ramp up pressure on lawmakers to fully repeal the law or risk retribution from the conservative grassroots.

If they hold together in the Senate, where Republicans hold just 52 seats, the three senators alone could sink a Republican bill.

“I’m in favor of complete repeal, similar to what we did in 2015,” Paul said this week as he left a closed-door Republican meeting in which House leaders presented a replacement plan to senators. “But I’m not in favor of keeping parts of Obamacare.”

Cruz and Lee used similar language in tweets this week. With reporters, Cruz was more circumspect, but he also left open the possibility of opposing the Republican plan. “The president laid out general principles of reform, and right now both houses of Congress are debating the specifics of those reforms,” he said.

The opposition of the three senators, all of whom credit the Obama-era Tea Party movement for their victories, has started a game of chicken with Republican leaders on the Hill as well as the Trump administration and millions of Americans who receive coverage through the ACA.

The coordinated opposition has also raised the spectre of a resurgent ideological right wing, which has appeared at least publicly to be in retreat since Trump’s victory. Many of Trump’s positions, including his desire to protect insurance coverage for Americans, run counter to conservative orthodoxy and leave room for a revolt.

But Trump’s continued popularity on the right puts these conservatives in a tough spot, should the president more fully embrace an emerging House plan to undo and replace key parts of the law. They risk alienating Trump’s loyal base – a prospect many lawmakers do not take lightly.

“I don’t want to draw a line and say that I’m against this proposal and I will put a no vote up,” said Rep. Steve King, R-Iowa, who prefers full repeal.

Still, for the many Republicans who were elected during Obama’s presidency with a mandate block his agenda, obstruction comes much more naturally than governance. The effort to repeal the ACA is the first major test of whether they can harness the energy they used to oppose the law to actually undo it – or whether ideological divisions will sink the effort.

“I think they should have done it by now,” said conservative activist Brent Bozell. “I’m just wondering when they are going to run out of excuses. It’s been six years’ worth of excuses.”

Few Republicans believe that Paul, Cruz, and Lee would oppose an effort to repeal the Affordable Care Act if the alternative is to keep the law in place. “I don’t pay any attention to them,” said Sen. John McCain, R-Ariz., when asked about his three colleagues.

But they are not the only ones who oppose some details of a plan being crafted by House Republicans. Some House conservatives, including King, don’t like what they see so far, either.

That plan calls for a refundable tax credit to help Americans afford the cost of insurance premiums, but that detail has raised objections among conservatives in both the House and Senate who believe it amounts to a new, expensive federal entitlement.

Conservative Republicans have long opposed refundable tax credits because Americans with lower incomes, whose tax bills are smaller, receive the full credit even if it exceeds their tax bill. Nonrefundable credits can be used only to offset actual tax liability – but would also mean less money in the pockets of Americans who need assistance to purchase health insurance.

As a result of that dispute and others, conservatives have slowly built support for a “full repeal” plan since the start of the year. Paul provided the only Republican “no” vote on January’s non-binding budget reconciliation instructions, saying that it added too much to the national debt; at the time, Lee and Cruz co-signed a letter saying they would be ready to oppose a later bill if it did not repeal the ACA.

On Tuesday, Paul, Cruz and Lee emerged at the same time from a GOP policy luncheon at the National Republican Senatorial Committee headquarters near the Capitol. As they descended the steps, a pack of reporters bombarded them with questions about health care. And conservatives hailed their apparent unity on pushing for a full repeal.

“If people don’t credibly think there are 51 votes for a plan, then the plan doesn’t go forward,” said Michael Needham, the president of Heritage Action for America. “It’s very helpful to have this bloc in the Senate, and in the House, saying they’re not going to take less than they got in 2015.”

After that vote two years ago, Paul introduced his own ACA replacement plan that was conditioned on a similar “full repeal.” Last month, the House Freedom Caucus endorsed that plan and got behind a companion bill by Rep. Mark Sanford, R-S.C. At a Heritage Foundation-sponsored roundtable with Freedom Caucus members, Lee said that a repeal bill “should not be anything less aggressive than what we were able to pass in 2015.”

To many Republicans, the current conflict is laden with deja vu. The Freedom Caucus had issued threats to oppose Republican budgets and to unseat then-Speaker of the House John Boehner; Cruz had floated the idea of a government shutdown over Planned Parenthood funding, then backed off.

In interviews, the supporters of the current strategy to kill “Obamacare-lite” argued that this fight was different. “This has been baking for seven years,” said Sanford. “Those other years came up much more immediately. They didn’t have the political urgency that repeal does.”

Cruz held forth with reporters outside the Senate chamber for 10 minutes on Wednesday morning, seeming to relish the chance to criticize the House leadership’s guidelines and pitch an alternative.

Ryan’s office spent Wednesday touting Trump’s mention of “tax credits” in his speech to a joint session of Congress as evidence that Republicans are coming together around the emerging House plan. But Cruz said that “the president did not attempt to introduce legislative language,” much less promise a new “entitlement,” as he described the refundable tax credits.

“If we fail to honor our commitment to repeal Obamacare, I believe the consequences would be quite rightly catastrophic,” Cruz warned in the same apocalyptic tone he often he used as a candidate for president.

Cheered by that kind of rhetoric, and planning their own public campaign for full repeal, conservative groups have promised to wage a public campaign against Republicans who buckle and save parts of the ACA.

“We’re going to be more strongly reminding Republicans of their promises made over the last eight years on the issue of stopping — or at least rolling back, anyway — government-run health-care,” said Tim Phillips, the president of Americans For Prosperity. “We’re telling them to keep their promises – and they’ve promised an unequivocal repeal of Obamacare.”

Founded by the billionaire donor David Koch, AFP has become an effective grassroots organization, stopping Republican legislators in Florida, Tennessee and Virginia from expanding Medicaid under the provision of the ACA or building health insurance exchanges. AFP, said Phillips, would demand that legislators pass full repeal “both in Washington in a very vocal way” and “also back home in their districts.” He declined to be more specific.

Adam Brandon, the president of FreedomWorks, said the group is organizing a “day of action” on March 15, with activists flooding the Hill to “put the heat” on Republicans who don’t support full repeal. They took it as a given that the Cruz/Lee/Paul troika would be with them.

“They’re damn serious,” he said. “It’s completely possible that the Ryan-Trump plan, when there is a plan, gets dropped. My jaw kind of hits the floor when I think that we’re even having a conversation about this.”

On the other hand, some Republicans believe that they can whittle down the conservative opposition as the chance of repealing the ACA, in part or whole, becomes more real. Sen. Bill Cassidy, R-La., the author of a bill that would allow states to keep most of the ACA if they preferred it, told reporters on Wednesday that Republicans could fulfill their promises if they repealed the most controversial parts of the law.

According to Cassidy, the mission of Republicans in Congress was not to pitch their ideal plans. It was to get right with what the president ran on.

“The American people voted for his vision,” said Cassidy. “More than any other single person in our country right now, he is in sync with the national mood. If folks want to go their own way, maybe they should run for president.”

The reporters assembled around, Cassidy began to laugh.

“Maybe they did,” said the senator.