"In the end, we realize that our fortunes all rise and fall together and we need to have an approach that gets 218 [votes] in the House and hopefully 51 in the Senate," Sen. John Thune said. | Getty GOP swimming in Obamacare replacements, but no consensus The plethora of options is making it far more difficult to repeal a law the GOP has spent six years trying to kill.

Republican leaders want to get their Obamacare repeal effort back on track. There’s a big problem, though: They’re neck-deep in competing plans to replace the law.

Nearly a half-dozen plans have been introduced or are coming — none with the broad support needed to get through Congress and win over the public. And that’s making it far more difficult to repeal a law the GOP has spent six years trying to kill.


“There’s no consensus,” said Sen. Bob Corker (R-Tenn.). “From my vantage point, there isn’t a consolidation around a particular thought yet.”

There’s no agreement on how much of Obamacare can be replaced through the budget reconciliation process in the Senate and only the murkiest of timelines when it comes to scrapping the law. The GOP wants to find a proposal that the whole party can get behind, but for now there are merely disparate ideas and warring factions fighting for attention.

Republican leaders are publicly keeping their powder dry, leading to a stream of divergent messages from rank-and-file lawmakers in public. But they’re working behind the scenes to try to keep the process streamlined and out of the firing line of centrists looking to preserve care for millions of low-income Americans and conservatives who want to repeal now and figure out the rest later.

“Everyone agrees there is an urgency to honor the promises we made,” said Sen. Ted Cruz (R-Texas) during a CNN debate with Sen. Bernie Sanders (I-Vt.) on Tuesday.





Cruz, of course, staked much of his political career on dismantling Obamacare. Republican leaders are moving more deliberately.

“I’m certainly hearing more people put less emphasis on the timeline and more emphasis on doing it right,” said Sen. Jeff Flake (R-Ariz.). “You see a lot of legislation introduced in the last couple of years that we knew would never see the light of day. Now that it is, it certainly causes you to be more careful.”

In recent weeks, Senate Majority Leader Mitch McConnell (R-Ky.) and House Speaker Paul Ryan (R-Wis.) convened a working group of key senators and House members to get down to brass tacks. And rank-and-file members are finally getting serious about sorting through the complex details needed to rework the Affordable Care Act.

“If you look at what the Republican proposals are — advancing refundable tax credits, getting power back to the states, general guidelines of where we should be instead the federal government prescribing them — there is so much common ground,” insisted Sen. Bill Cassidy (R-La.). “It’s 90 percent there.”

But instead of a groundswell of support for a single bill, alternatives are mushrooming. There’s the plan from Sens. Cassidy and Susan Collins, which would give states the ability to craft their own health care plans, including keeping Obamacare. There’s Sen. Rand Paul’s proposal, which mostly scraps Obamacare with minimal replacement. The House Freedom Caucus wants to introduce its own bill similar to Paul’s. And Rep. Darrell Issa (R-Calif.) wants to just open up the federal employee health care plan to all Americans.

There are more to come. Top House Republicans are preparing to introduce new legislation next week that would start the repeal-and-replace process. And once Rep. Tom Price is confirmed as secretary of Health and Human Services, President Donald Trump is expected to release a proposal.

Some Republicans are looking to the White House to provide some guidance before weighing in.





“It’s hard to see how this gets done unless the president says, ‘OK, let’s do it this way,’” said Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor and Pensions Committee. “We’ve got our own ideas and we’ll pass our own bill, but it’s hard to do anything this complex unless the president is directly involved.”

Once Trump releases a plan, Republicans on Capitol Hill hope to use it to write their own bill, Alexander said, pointing to the McConnell-Ryan working group, which first met several weeks ago. “The result of that meeting was a more structured process between the Senate and House staffs. We’re making good progress,” Alexander said.

The Tennessee senator has met Trump only once, though he and other Republicans are heading to the White House on Thursday for lunch with the president and moderate Democratic senators.

Republican leaders hope that the Trump plan — and the leadership-driven bill that follows — will clear the crowded field of health plans.

“Everyone is kind of putting their markers out there right now and trying to use it to gain leverage in the conversation,” said Sen. John Thune (R-S.D.). “But in the end, we realize that our fortunes all rise and fall together and we need to have an approach that gets 218 [votes] in the House and hopefully 51 in the Senate.”

Republicans are wading into what’s likely to be their thorniest legislative battle of the year. After using opposition to the law to drive their political strategy, they are now pumping the brakes on their repeal efforts until they have a replacement bill to back it up. The reason: GOP lawmakers realize now that they’re now firing “real bullets,” as Flake puts it, instead of merely engaging in a political exercise.

As they gird for Trump and party leaders to begin coalescing behind a plan, Republicans are scrambling to build support. Paul visited last week with the hard-line House Freedom Caucus, hoping to build support on the right for his legislation. And Collins and Cassidy are pressing more GOP senators to join their more centrist plan, arguing that Paul’s proposal is insufficient.

“I certainly don’t expect ours to be the only one out there. But it’s the first comprehensive bill that’s been introduced,” Collins said. “I give Rand credit for putting out an idea. But it’s not comprehensive.”

But will Republicans be able to pass a sweeping bill after criticizing Democrats for doing so with Obamacare? Several senators said no, they believe they will have to pass a series of piecemeal measures, starting with rolling as much replacement language as possible into a repeal bill passed with all GOP votes. At the same time, they’ll look to Price to make changes to the legislation before they try to work with Democrats to pass more health care laws with a 60-vote threshold in the Senate.

Those bills will have to fix the reeling insurance market exchanges, preserve health care coverage for millions of Americans under Medicaid expansion and provide better health-care plans to people for lower costs, all without blowing a hole in the budget. And executing it is proving just as complicated as it sounds.

“There’s talk of just totally excluding — not in the Senate, but on the House side — Medicaid expansion. That’s 184,000 people in my state,” said Sen. Shelley Moore Capito (R-W.Va.). “That’s problematic.”

