Michael Collins

USA TODAY NETWORK - Tennessee

WASHINGTON – Sen. Lamar Alexander sees the Republican healthcare plan released this week as a good start toward repealing and replacing the reforms enacted under former President Barack Obama, but he’s not yet ready to commit to voting for the package.

“Let’s wait to see what comes out of the House,” which is currently reviewing the legislation, the Tennessee Republican said.

The legislation, which would strip away many of the reforms put in place under the Affordable Care Act but leave some of the law’s more popular provisions intact, cleared its first hurdles in Congress on Thursday when Republicans on two committees advanced the bill after marathon discussions.

The House Ways and Means Committee approved the legislation in a pre-dawn, 23-16 party-line vote after nearly 18 hours of debate. Later, the House Energy and Commerce Committee voted 31 to 23 to advance the bill after more than 27 hours of discussion

The legislation still has to clear the House Budget Committee, chaired by Rep. Diane Black, R-Gallatin, before it goes to the floor for a vote.

In the Senate, Alexander chairs the committee that has jurisdiction over healthcare issues. But when the bill clears the House and arrives in the Senate, Republican leaders are prepared to bypass Alexander’s committee and take the legislation directly to the Senate floor for a vote.

In an interview with the USA Today Network-Tennessee, Alexander said he has no problem with that approach.

“We’ve given it plenty of hearings,” he said of the GOP plan. “There’s nothing new in the bill, really. We’ve debated it and heard it for six years. For the last five weeks, our committee has been working with the committees in the House and the Finance Committee in the Senate. We’ve been actively involved in consulting on the bill. I’m satisfied with it so far, and we’ll just have to see what the best way is to bring it (to the Senate) and get a result.”

When Democrats approved Obama’s health reform bill, the Affordable Care Act, without any GOP support in 2010, Republicans accused them of rushing the measure through Congress too quickly. Alexander rejected arguments from Democrats that Republicans are doing the same thing with their replacement bill.

Democrats “are doing in reverse what they did (more than) six years ago,” he said. “Six years ago, they wouldn’t allow us to participate in the writing of the bill, which was a mistake. And now, they’re refusing to participate in the fixing of the bill, which is a mistake.”

Democrats and Republicans who have raised objections to all or parts of the bill will get a chance to offer amendments on the Senate floor, Alexander said.

“The question,” he said, “is whether they will.”

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The GOP plan, released Monday evening by House Republicans and called the American Health Care Act, would essentially gut Obama’s requirement that every American buy insurance by repealing the tax fines on those who don’t.

It also would replace income-based subsidies put in place under Obama to help low-income people buy insurance and replace them with age-based taxed credits. Insurers would be allowed to charge higher premiums to people who allow their policies to lapse, a provision intended to discourage people from buying insurance only when they get sick.

The GOP approach has come under fire from Democrats, who argue it would take health coverage away from many of the 20 million Americans who were insured under Obama’s law and that it would drive up costs for others because the GOP tax breaks would not be as generous as the existing subsidies.

Conservative Republicans in the House and Senate and some outside groups also have slammed the bill, saying it creates a new entitlement program and leaves too much of Obamacare and its taxes in place.

The Congressional Budget Office has yet to release its cost analysis of the bill, which also would indicate how many Americans could lose health insurance under the plan. But the Kaiser Family Foundation and other analysts have said older Americans who have low incomes and live in areas where insurance is expensive would end up paying more under the Republican plan.

In Tennessee, for example, a 60-year-old who lives in Knox, Davidson or Shelby counties and earns $30,000 a year would lose more than $6,000, or 60 percent, of their subsidies by 2020, according to Kaiser’s analysis.

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Regardless, Alexander predicted the GOP plan would bring stability and more choices to the insurance market in Tennessee, where Insurance Commissioner Julie Mix McPeak has warned that the exodus of insurers has left the Obamacare exchange, or market, near collapse. More than 230,000 Tennesseans bought insurance on one of the Obamacare exchanges last year. That's roughly 3.5 percent of all Tennesseans.

Alexander said one of the things he likes most about the GOP plan is that it would allow 40,000 residents in the Knoxville area who buy their health insurance on the Obamacare exchange to use their subsidies to purchase insurance on the open market. Without that provision, they will be unable to buy a policy because the insurance giant Humana, the sole provider on the federal exchange in Knoxville, has said it will exit the market in 2018.

That “would be like having a bus ticket in a town with no buses running,” Alexander said. “These are some of the most vulnerable people in our state who need help buying insurance, and they literally won’t have any insurance to buy unless Congress acts.”

Congress is hoping to send their healthcare replacement bill to President Trump’s desk by April.

Reach Michael Collins at 703-854-8927, at mcollins2@gannett.com or on Twitter at @mcollinsNEWS.