In the House, Republicans plan to work off of House Speaker Paul Ryan's Better Way agenda, a white paper that outlined giving people assistance through refundable tax credits to buy health insurance with a strong focus on encouraging health savings accounts. | Getty Republicans could keep parts of Obamacare for up to four years

Congressional Republicans say they will vote on repealing and replacing Obamacare “very quickly” early next year but may keep Obamacare in place for as long as four years.

The incoming Trump administration and Republicans on Capitol Hill are sorting out the details of how to best deconstruct the Affordable Care Act. One of the thorniest problems is how long to leave parts of the law intact — to give 20 million Americans time to find other arrangements and health insurance companies the ability to develop and price new plans.


“We need to talk with all the other parties in this and make sure that we have a smooth and stable transition,” said a senior GOP congressional aide. “That’s what is going to drive what we do — not necessarily what works best politically.”

Conservatives in the House Freedom Caucus want as little as a six-month transition period. But insurance companies argue they need at least an 18-month window to price insurance plans and to adjust to new market rules.

Previous conversations had capped the transition at about three years, but senior Republican congressional aides on Thursday indicated that could be up to four years. After a version of this story was published, one aide said a four-year transition had not been discussed internally.

The repeal will happen “very quickly” after the new Congress is sworn in, the aides said, noting that the development of replacement plans will be handled as urgent business. A longer transition period doesn’t mean the process will unfold slowly, they said.

“Obamacare is a 100-day item for the administration -- both repeal and replace. I don’t think we’re wasting any time on how we litigate” the details, one aide said. Sorting them out “could take weeks, it could take a month or two. I wouldn’t expect anyone to be satisfied with waiting six months to get resolution on it.”

Republicans are considering enacting their replacement piecemeal, with small bills that tackle one part of the health care system at a time. Their goal will be to expand access to health care by reducing insurance costs and federal regulation. In contrast, Democrats’ goal in fashioning the Affordable Care Act was to expand health insurance coverage. The GOP argument is that reducing premiums will get more people covered but it is unclear whether that will be borne out.

Still, there are many unanswered questions about how Republicans will proceed: In the House, they plan to work off of House Speaker Paul Ryan’s Better Way agenda, a white paper that outlined giving people assistance through refundable tax credits to buy health insurance with a strong focus on encouraging health savings accounts. But that has yet to be translated to legislative text.

Republicans also haven’t sorted out whether they will encourage insurance companies to stay in the insurance markets through the transition period. Congressional aides said on Thursday said that that will largely be up to the Trump administration, but they didn’t close the door on helping insurers through the transition period.

The Senate plans to kick off the repeal effort with a Jan. 3 vote on a proposed budget, which would allow Republicans to use a special procedural motion that doesn’t allow a Democratic filibuster. The House would vote quickly afterward.

From there, the House would hold committee hearings and markups on the repeal legislation, pass it on the floor and send it to the Senate. That bill is expected to look very similar to a 2015 bill that repealed huge parts of the health care law, including the individual and employer insurance mandates, federal subsidies to help people purchase insurance and Medicaid expansion.

If the Senate can use that legislation to repeal more of the law, they will do so, aides said. Several Republicans want the bill to also repeal the requirement that insurance plans cover a broad range of treatments and illnesses — a list that they say is too long and is driving up premiums. One Republican aide said they’re fairly confident that Senate rules wouldn’t allow them to add those provisions to the repeal bill.

From there, any differences would be sorted out between the chambers and sent to the White House, where President-elect Donald Trump has said that he would repeal Obamacare.

Rachael Bade contributed to this report.