By Joe Williams, CQ Roll Call
December 12, 2016 -- Senate Majority Leader Mitch McConnell on Monday confirmed that Republicans will take steps early next year to repeal aspects of President Barack Obama's signature health law before a replacement system is put in place.
His comments come as some GOP lawmakers in Congress have said a blueprint for replacement should be established before any repeal action is taken to gut the 2010 health care overhaul.
"We will move right after the first of the year on an Obamacare [repeal] resolution and then we will work expeditiously to come up with a better proposal than current law," the Kentucky Republican told reporters.
Republicans in Congress hope to include in the repeal a transition period, but McConnell said the timing of that transition has yet to be determined.
A number of key interest groups have voiced concerns over the past few weeks about the impact that repeal without a replacement would have on the insurance marketplace.
"Delaying enactment of a replacement for two or three years, and leaving insurers without any certainty in projecting risk, could lead to the collapse of the individual health insurance market with long-term consequences," Chris Hansen, president of the American Cancer Society Cancer Action Network, said in a statement last week.
Health and Human Services Secretary Sylvia Mathews Burwell last week discussed with Senate Democrats the chaos that would ensue if repeal were to be enacted without a replacement mechanism in place, according to lawmakers leaving the meeting. Democratic allies, such as Families USA, union groups and the National Partnership for Women and Families, are launching digital and print ad buys in five states and Washington, D.C., through a new coalition known as the Alliance for Healthcare Security.
Some GOP lawmakers are concerned about the potential impact of moving forward with repeal without an alternative system.
"It's important to outline a framework at the same time that we're revamping" the health law, Sen. Susan Collins, R-Maine, told reporters last week. "If we wait until the end of the transition time to develop a replacement, it's not going to work."
Collins' remarks echoed similar comments she made in an earlier interview with CQ Roll Call.
Nearly unified support from Senate Republicans will be necessary to pass a repeal bill. Despite plans to use a budget tactic known as reconciliation that requires only 51 votes to pass, the GOP will only hold 52 seats in the Senate next year. Vice President-elect Mike Pence could provide the 51st vote after Jan. 20. But even a few defections could force Republicans to pressure Democrats running for re-election in 2018 such as Sen. Joe Manchin III, D-W.Va., to switch their votes and support repeal.
Congress last year passed repeal legislation (HR 3762) using the same method that was then vetoed by Obama.
Key lawmakers, like Senate Health, Education, Labor and Pensions Chairman Lamar Alexander, have said a transition period is necessary so a new system can be put in place before the health law is completely repealed.
"Congress should replace and repeal at the same time, which requires figuring out how to replace it before fully repealing it. To avoid the historic mistakes of Obamacare, that replacement should be implemented step by step to minimize disruptions and make sure the changes in the system work well," the Tennessee Republican told CQ Roll Call.
McConnell on Monday declined to comment on whether Republicans would pursue a piecemeal approach to replacement.
President-elect Donald Trump has voiced support for keeping aspects of Obama's health law, like a provision that prevents insurers from denying coverage to individuals with pre-existing medical conditions. A report released Monday from the Kaiser Family Foundation found that 52 million adults under 65 would likely be unable to obtain insurance in the individual market should that provision be repealed.
But Republicans are likely to repeal a key measure included in the health overhaul that requires U.S. citizens to purchase insurance or pay a yearly fine. Without that requirement, many health experts say healthy individuals could opt out of buying coverage. That could leave an increasing percentage of sick individuals in the marketplaces, which could result in drastically higher premiums and set off a so-called death spiral in the individual insurance market.
America's Health Insurance Plans, the industry's main trade group, previously signaled it would support a repeal of the mandate if Congress were to provide additional incentives to support insurance companies and bring healthier individuals into the marketplace.
Republican lawmakers appear to be divided on whether those incentives would mean additional federal support for insurance companies.
"As far as the broader picture of a replacement and how we deal with the current tax treatment, that's something we are going through," Sen. Marco Rubio, R-Fla., told CQ Roll Call, adding that he does not want to see any federal funding go to help insurance companies.
However, several lawmakers, like Alexander and Sen. Bill Cassidy, R-La., have kept open the possibility that additional money could go to help the insurance industry following repeal.
