Axios Pro: Health Care Policy

November 29, 2023

Axios Pro Exclusive Content

Happy hump day. Members of Congress are buzzing over former President Trump's call to repeal Obamacare, and we have a pulse check on who's open to another repeal-replace experience.

  • Plus, there are some big new ad buys calling for hospital payment reforms, possibly as part of a government funding deal.

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1 big thing: GOP cautious but open to ACA repeal

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

Illustration: Gabriella Turrisi/Axios

Congressional Republicans may not be thrilled with former President Trump's renewed push to repeal and replace Obamacare — but few are firmly ruling it out, Peter reports.

Why it matters: Roughly 40 million people are now covered by the Affordable Care Act, making any repeal exercise as perilous as it was in 2017, when Democrats scored big electoral gains and retook the House.

  • But Trump's continued fixation with the law could put the GOP under extreme pressure to make another run at it if they win back the White House and gain full control of Congress 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. "I mean just look at your health care premiums."
  • But he added he would "be interested to hear exactly how he [Trump] would try to accomplish it."
  • Sen. Mike Crapo, in line to be Finance Committee chairman in a GOP Senate, said he's still open to proposals similar to the 2017 repeal and replace bills.

Yes, but: Other mostly moderate Republicans threw cold water on Trump's Truth Social post, saying 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 HELP 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 no on repeal last time.

The big picture: The Affordable Care Act is now even more ingrained into the health care system than it was in 2017. Enrollment in the law's marketplaces has hit record levels and the Medicaid expansion rolls have also swelled.

  • The law's protections for people with pre-existing conditions have also proven to be particularly popular.

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

  • Rep. Bob Good, a conservative rebel in the House, succinctly replied "yes" on Wednesday when asked if he is still interested in replacing Obamacare.
  • On the more moderate end in the House, Rep. Brian Fitzpatrick told Axios, "I voted against ACA repeal every time it's gone up, and I would again."
  • Rep. Kevin Hern, chairman of the conservative Republican Study Committee, summed it up by arguing the law is failing and "prices have risen" under it.
  • He said of Trump: "I'd certainly love to look at his plan."

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