Republicans revising timing on Obamacare replacement

Madison — As Wisconsin Republicans take up the massive task of repealing and replacing Obamacare, they're still working out the most basic elements of how — and when — to do it.

The question of approach could be much more than a cosmetic difference: people's health, livelihoods and tax dollars could all be at stake.

Moving too quickly with a replacement for the Affordable Care Act could lead to a poor plan or a botched implementation. Going too slowly might leave dangerous uncertainty in the insurance markets and rob the public of its right to weigh in on a replacement plan.

Newly re-elected U.S. Sen. Ron Johnson of Wisconsin says the White House and Congress shouldn't overestimate their ability to quickly remake a whole industry in a diverse nation.

Johnson "doesn’t believe we will see one massive plan. Instead, the approach will probably be a step-by-step targeting of the individual provisions that most hurt people’s health coverage. It will be an ongoing process of transitioning from Obamacare, which failed, to something that works," aide Patrick McIlheran said.

But Johnson's approach isn't the only one that's been floated by Republicans in recent weeks. The differences reflect the complexity of the task ahead of them, both in terms of policy and politics.

Republicans are in agreement on many aspects of their health care overhaul, such as removing the individual mandate that people buy health coverage and giving more financial incentives to consumers to purchase health care wisely. But how to get there is trickier.

Gov. Scott Walker, the chairman of the Republican Governors Association, staked out an early position calling for a quick repeal of the law but a longer phaseout. As recently as Wednesday, Walker told reporters in Milwaukee that the federal government should take an immediate vote to repeal the Affordable Care Act but then set in motion a reasonable timeline to get a new and better system up and running.

U.S. Speaker of the House Paul Ryan of Janesville said as recently as last month that “it will clearly take time” to craft and implement a replacement to Obamacare.

“It’s not going to be replaced come next football season,” he told the Milwaukee Journal Sentinel in December.

But Ryan said this week that Republicans want to repeal it and replace it at roughly the same time, as President-elect Donald Trump has called for.

“We want to do this at the same time and in some cases in the same bill," Ryan said Thursday.

U.S. Rep. Mark Pocan, a Madison Democrat, said that he believes Republicans are certain to advance parts of an Obamacare repeal. But coming up with a detailed replacement can't be done in a time frame of weeks or a month or two, he said.

"Anything that they say is a replacement plan will be at best a statement of principles," Pocan said.

Last week, Congress took the first step toward repeal by voting to start a legislative process known as reconciliation.

That has the advantage of allowing the U.S. Senate to pass a repeal measure without needing a filibuster-proof majority of 60 votes. But it also has the downside of being unable to necessarily pass all the elements that are likely needed in a replacement plan, said Donna Friedsam, director of Health policy programs at the University of Wisconsin Population Health Institute.

U.S. Sen. Tammy Baldwin is holding a rally on Sunday with U.S. Rep. Gwen Moore of Milwaukee at Candelas Banquet & Conference Facility in Milwaukee to argue for protecting Obamacare, saying it's provided coverage for millions nationally and hundreds of thousands of people in Wisconsin.

In a statement, Baldwin said that by taking the first step in the repeal process Senate Republicans had essentially violated Trump's approach of holding back on erasing Obamacare until a replacement is formulated. Voters should be able to evaluate the GOP plan before the Affordable Care Act is removed, she said.

"The public has a right to see the congressional Republican plan to put insurance companies back in charge of health care and increase prescription drug costs, premiums, and out-of-pocket expenses for Wisconsin families," Baldwin said.

Republicans should already be able to show the public their plan already, given that they've campaigned against Obamacare since 2010, Gwen Moore said.

"They've had years," she said.

State Rep. Joe Sanfelippo (R-West Allis), chairman of the Assembly Health Committee, said at a Wisconsin Health News forum Thursday that he doesn't want to see a drop in coverage rates after Obamacare is repealed.

But Sanfelippo said he didn't think Republicans needed to show all of their replacement plan before rolling back parts of the Affordable Care Act. Voters gave the GOP the chance to do a rewrite, he said.

"In the end the people are telling us to make the change," he said.

Erin Richards of the Journal Sentinel staff in Milwaukee contributed to this report.

Jason Stein can be contacted at jstein@jrn.com.