The goal is to begin work on the legislation in the relevant House committees by the end of February. | Getty Obamacare repeal-replace effort begins to jell Four replacement measures are under consideration.

Republicans on Capitol Hill and within the Trump administration are scrambling to get Obamacare repeal efforts back on track by stuffing as much of a replacement policy as possible into a repeal bill.

Four replacement measures are under consideration, with a goal of beginning work on the legislation in the relevant House committees by the end of February, according to congressional sources familiar with the tentative plans.


The GOP's emerging blueprint would include expanding Health Savings Accounts, enacting high-risk health insurance pools, reforming Medicaid and authorizing tax credits to help Americans buy insurance policies.

After months of doubts and debate, the developments could win over wavering Republicans who've been insisting that repeal and replace be taken up simultaneously. Their ambivalence scuttled GOP expectations of making quick work of repeal. Now, they're hoping to get the next key vote in March.

The replacement policies would be rolled into a measure repealing the 2010 health care law, which will be taken up and passed under an expedited process only requiring 51 votes for passage in the Senate. It’s still unclear whether the Senate parliamentarian will allow the replacement pieces to be inserted into the bill. But if she signs off, the policies could provide reassurance to GOP lawmakers eager to make good on longstanding vows to scrap the health law who want to vote on some replacement policy at the same time.

Vice President Mike Pence told House Republicans on Tuesday in a closed-door meeting that the administration is committed to repeal and that the bill can include much more policy than Republicans first thought, according to attendees.

The confirmation of HHS secretary designee Tom Price — expected to occur this week — could speed up the process as well. President Donald Trump has said his administration would release an Obamacare replacement plan as soon as Price is confirmed. In addition, Price is expected to release executive orders addressing aspects of the law soon after he is sworn in.

Sources on and off the Hill say the process is in its early stages and could still change. It's still unclear whether a repeal-replace bill would get enough support to pass — or how quickly. House Speaker Paul Ryan said at last month’s Republican retreat that the House will pass Obamacare repeal by March or April.

“We’re working on this. This is a big subject to deal with,” said Sen. Lamar Alexander (R-Tenn.). “We want to do that as rapidly as we can. But speaking for myself, I’m not interested in a quick fix, I’m interest in a good result.”

House Majority Whip Steve Scalise’s office is holding listening sessions with rank-and-file lawmakers next week on the Health Savings Account and Medicaid policies. Several additional briefings for staffers are planned as well.

Medicaid is proving to be the most complex piece of a replace plan in the repeal bill. Republicans want to dramatically overhaul the program by imposing spending caps tied to the number of enrollees in a state. But they are running into problems sorting out such details as whether funding should be allocated based on state enrollment before Obamacare or after.

Because Democrats would almost certainly oppose such a plan — which is called “per capita caps” — Republicans need to attach it to a repeal bill or would have to peel off at least eight Senate Democratic votes later on to overcome an anticipated filibuster.

Even if Republicans sort out the details on Medicaid policy, it's unclear whether they will attach them to the repeal bill or pursue smaller Medicaid reforms in the repeal bill.

The refundable tax credits under consideration mirror the policy House Republican leadership included in its "Better Way" agenda last year, according to sources familiar with the plans. Consumers would get a tax credit — adjusted for circumstances such as family size — to help them buy insurance. The credits would replace Obamacare subsidies used for the same purpose.

Some Republicans are also hoping that the bill could include funding for an Obamacare cost-sharing subsidy program, the focus of a lawsuit filed by the House against the Obama administration over how the program was funded.