House Speaker Paul Ryan of Wis., accompanied by House Majority Leader Kevin McCarthy of Calif., meets with reporters on Capitol Hill on Jan. 10 to discuss efforts to replace the Affordable Care Act. | AP Photo How the GOP plans to repeal Obamacare A step-by-step primer.

The Republican Party’s quest to kill Obamacare is about to get real.

Here’s a step-by-step guide to how it will go down in the coming days and weeks — assuming they don’t manage to mess it up or get cold feet.


In the wee hours of Wednesday night or Thursday morning, Republicans plan to pass a Senate budget that sets in motion what’s known in congressional parlance as reconciliation. If that sounds like a snooze, think again: It’s one of the most powerful weapons in the majority’s procedural arsenal. Under reconciliation, bills are protected from the 60-vote filibuster so they can be rammed through the Senate and House by a simple majority. Democrats used it to finish passing Obamacare seven years ago. Now Republicans intend to return the favor to dismantle the law.

There's a hitch, though: Under budget reconciliation, only provisions that affect federal spending or taxes can be targeted. That means Republicans cannot completely eliminate or replace the law in one fell swoop. The final call on what can or cannot be addressed in a reconciliation bill will be made by the Senate parliamentarian.

The GOP did a dry-run in the last Congress, passing a reconciliation bill that killed key parts of Obamacare, including the individual mandate, insurance subsidies for consumers and the Medicaid expansion; for good measure, it also defunded Planned Parenthood for a year. President Barack Obama vetoed the legislation but that won’t be an issue this year with Donald Trump in the White House.

But the budget and accompanying reconciliation language is a sure thing to clear the Senate, and the House is expected to quickly follow suit, passing it as early as Friday. The budget doesn’t become law, but it’s the only way to set reconciliation — in other words, Obamacare repeal — in motion.

Then comes the hard part: Lawmakers actually have to write the bill to repeal Obamacare. The budget currently instructs several committees to draft legislation to gut the health law by Jan. 27. But a handful of Senate Republicans are pushing to delay the deadline until March 3 to give the GOP more time to come up with a replacement.

Rank-and-file Republicans in the House and Senate are growing increasingly fearful that repealing the health law without having a replacement ready would be disastrous. Nearly 30 million Americans would lose health insurance by 2019, the Urban Institute estimates. Chaos could descend on health insurance companies and hospitals, with the hit to the $3 trillion health system potentially undermining the broader U.S. economy.

The big question after that is when, exactly, Republicans will reveal their own plan to remake the nation’s health care system. The answer is anyone’s guess, and it means the fight could drag out for weeks, months or years.

Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan have promised a smooth transition out of Obamacare, by passing repeal but delaying when it would take effect for two years or more. But that’s easier said than done, and some Republicans — including President-elect Donald Trump — say Republicans need to come up with a replacement pronto.

That brings us back to reconciliation. Republicans are realizing it isn’t a silver bullet.

Completely replacing Obamacare would mean action on legislation that doesn’t touch on budgetary matters and must be done outside of the reconciliation process. Crucial parts of the law, like protections for people with pre-existing conditions and key insurance coverage standards, cannot be targeted under reconciliation. And because the health care system is so intricately tied together, pulling just one thread could unravel the whole thing.

A full replacement bill done outside of budget reconciliation would require Democratic votes to get over the Senate’s 60-vote filibuster threshold. Republican leaders, who are pledging a gradual transition, hope to pressure Democrats into working with them on a replacement bill in the future, but Senate Minority leader Chuck Schumer has vowed that Democrats won’t lift a finger to help Republicans strip health insurance from millions.

GOP leaders remain confident that Congress will repeal the health law through reconciliation — a promise it has made for years. But the politics are clearly treacherous, and even Trump is sounding a cautious note. “Republicans must be careful,” he tweeted last week.