Mitch McConnell says party is ‘acting quickly’ and an alternative will come soon – but observers fear replacement process could take years

After seven years of failed attempts to repeal Barack Obama’s healthcare law, Republicans finally have their chance.

This week, Republicans on Capitol Hill will press ahead with their plan to dismantle the Affordable Care Act as the White House sounds the alarm on their “repeal and replace later” approach.

The health and human services secretary, Sylvia Burwell, warned on Monday that abolishing the law with no replacement in place would disrupt the nation’s $3tn-a-year healthcare system and leave millions of patients without care.

“Our only chance of not going over that cliff depends on opponents of the law doing in the next two years what they haven’t done in the past six – develop a comprehensive replacement plan,” Burwell said in a farewell address at the National Press Club.

Burwell said lawmakers should ask themselves three questions when considering replacement legislation: does it cover as many people? Does it maintain the quality of coverage? And does it “keep bending the healthcare cost curve in the right direction?”



Asked about alternative proposals brought forward by Republicans, she said: “I think we haven’t seen a real proposal for replacement.”

Burwell’s speech matched remarks by President Obama over the last few days in defense of the healthcare law, in which he has admitted that it needs to be improved but made the case against its repeal.

After a clean sweep of Congress and the White House, Republicans will have no problem dismantling the 2010 law that they vehemently opposed from the outset. The much more complicated question – one Republicans have yet to agree on – is how to overhaul the system without eliminating coverage for the 20 million people who now have insurance through the Affordable Care Act.

“We’re acting quickly because Obamacare is collapsing under its own weight, and things will continue to get worse otherwise,” the Senate majority leader, Mitch McConnell, wrote in an op-ed for Fox News published on Monday.

“That doesn’t mean the law will end overnight. There will be a stable transition period, and once repeal is passed we will turn to replacement policies that cost less and work better than what we have now.”

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On Sunday, McConnell said he expected the Senate to take its “first steps” toward unwinding the law by the end of the week and that Republicans would produce an alternative “soon”. The timeline between repealing and replacing the law should be short, he said.

“You have to both repeal and replace, and I think there ought not to be a great gap between the first step and the second,” McConnell said on CBS’ Face the Nation. Pressed on whether someone who is currently covered under the healthcare law would have insurance after it was repealed, McConnell demurred.

In his Fox News op-ed, McConnell called for Democratic support in the repeal process, writing: “We want their ideas to improve our healthcare system. We want to find ways to work together on this important issue.”

Last week, Obama said he would support the repeal of his biggest legislative achievement if Republicans came up with something better – though he expressed doubt that it will happen.

“I am saying to every Republican right now, if you in fact can put together a plan right now that is demonstrably better than what Obamacare is doing, I will publicly support repealing Obamacare and replacing it with your plan,” Obama said in an interview with Vox on Friday. “But I want to see it first.”

The president is using his final days in office to galvanize support, criticizing Republicans’ determination to gut his law without a clear plan.

“‘Repeal and replace’ is a deceptively catchy phrase,” Obama wrote in an essay for the New England Journal of Medicine, published on Friday. “The truth is that healthcare reform is complex, with many interlocking pieces, so that undoing some of it may undo all of it.”

Republicans do not have the votes to pass an outright repeal of the law. They are using an expedited process known as a budget reconciliation that will enable them to dismantle key provisions of the law with a simple 51-vote majority in the Senate.

Republicans have not formed a consensus around an Obamacare replacement, a debate some say could take 18 months or more. They will probably need Democrats’ help to pass a new healthcare law, but the party has so far indicated no willingness to help.

“They want to repeal it and then try to hang it on us,” the Senate minority leader, Chuck Schumer, said last week. “Not going to happen. It’s their responsibility, plain and simple.”

Only a handful of Democrats from conservative states have indicated that they could work with Republicans to replace the law.

While popular opinion is split over the merits of the healthcare law, many of its provisions continue to enjoy high levels of support from voters of both parties, according to a November tracking poll by the Kaiser Family Foundation.

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Donald Trump has expressed support for certain provisions, including measures that bar insurance agencies from refusing to cover people with pre-existing conditions and allow young people to stay on their parents’ health insurance until age 26. Last week, Trump pledged in a tweet to replace the healthcare plan with something “less expensive & FAR BETTER!”

Last week, Kellyanne Conway, a top Trump adviser, said it was “correct” that people currently covered by the law would not lose their insurance.



“We don’t want anyone who currently has insurance to not have insurance,” Conway said on MSNBC. “Also, we are very aware that the public likes coverage for pre-existing conditions. There are some pieces of merit in the current plan.”

Congressional Republicans and the president-elect have yet to agree on a viable alternative to Obamacare. The Republican senator Rand Paul split with his party last week in a vote on legislation that would abolish the law.



