Nov 30, 2023 - Health

GOP lawmakers cautiously open to Trump's ACA repeal push

Illustration of a stethoscope draped over the dome of the US Capitol building.

Illustration: Gabriella Turrisi/Axios

Republican lawmakers may not be thrilled with former President Trump's renewed push to repeal and replace Obamacare — but few are firmly ruling it out.

Why it matters: The Affordable Care Act has become more popular and even more entrenched in the health care system since the GOP's failed repeal attempt in 2017 contributed to Democrats' big electoral gains the following year.

  • A fresh repeal effort could be just as perilous, but Trump's continued fixation with the law could put pressure on Republican lawmakers to make another run at it if the GOP gains full control of Washington next year.

What they're saying: Two top Senate Republicans signaled they could be open to a revived effort.

  • "I think Obamacare has been one of the biggest deceptions on the American people," said Sen. John Cornyn (R-Texas). "I mean just look at your health care premiums."
  • But he added he would "be interested to hear exactly how" Trump would approach repeal.
  • Trump in a social media post late Tuesday night reprised his attack on the health care law, while emphasizing that he wants to "replace" it with a still-unspecified "MUCH BETTER" plan.

Republican lawmakers haven't taken a serious look at what "repeal and replace" might look like today, when 40 million people are covered by the ACA's subsidized marketplaces and Medicaid expansion.

  • Sen. Mike Crapo (R-Idaho), who's in line to run the Finance Committee if the GOP retakes the Senate, said he's open to plans that were similar to the 2017 repeal and replace bills.
  • Leading proposals generally would have curtailed spending on ACA subsidies and Medicaid expansion — resulting in an estimated millions losing coverage — while relaxing federal insurance protections like those for people with pre-existing conditions.
  • "It wouldn't have been repealing all of it ... it would really have been a reform of the entire health care system that Obamacare created," Crapo told Axios. "I still support that, but I just don't think it's right to characterize it in terms of repealing."

Yes, but: Other mostly moderate Republicans threw cold water on Trump's comment the GOP should "never give up" on replacing the health law.

  • "I spend my [time] on things that can pass," said Sen. Bill Cassidy, the top Republican on the Senate health committee.
  • "I don't hear any Republican talking about it," said Sen. Chuck Grassley.
  • "I don't think that's going to happen," said Sen. Susan Collins, who voted against repeal in 2017. She added she is open to "improvements" in the law.

The big picture: About 6 in 10 adults view the law favorably, according to KFF surveys. Republicans still have an unfavorable view of the law, but repeal has not been a priority for a few years.

What we're watching: In 2017, the Senate proved to be a tougher sell on repeal than the House.

  • Rep. Bob Good (R-Va.), an ultraconservative, succinctly replied "yes" on Wednesday when asked if he is still interested in replacing Obamacare.
  • Rep. Brian Fitzpatrick (R-Pa.), from the more moderate wing of the House GOP, noted that he regularly voted against ACA repeal in the past. "I would again," he said.
  • Rep. Kevin Hern of Oklahoma, who leads the conservative Republican Study Committee, argued the ACA is failing but wondered what specifics Trump had in mind.
  • He said of Trump: "I'd certainly love to look at his plan."

Victoria Knight contributed to this report.

A version of this story was published first on Axios Pro. Unlock more news like this by talking to our sales team.

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