GOP’s Plan B for Obamacare -- repeal first, replace later -- began with quiet push from Koch network

Sen. Ben Sasse (R-Neb.) talks on his phone outside the Senate office buildings on Capitol Hill.
(Mark Wilson/Getty Images)

President Trump’s surprise suggestion Friday that deadlocked Senate Republicans shift their focus to simply repealing Obamacare — and worry about replacing it later — has its roots in a Koch network proposal that has been shopped around Congress for months.

The influential Koch network, backed by the billionaire industrialists, floated the idea most recently at a retreat last weekend in Colorado Springs, Colo., where key conservative lawmakers heard an earful from frustrated GOP donors about the party’s failure to deliver on their signature campaign promise.

Among those attending the gathering at the luxurious Broadmoor Hotel was Republican Sen. Ben Sasse of Nebraska, who has been working with the White House behind the scenes on the idea.

On Friday, as GOP leaders left Washington still unable to agree how to revamp the Affordable Care Act, Sasse went public with the proposal.

“This two-step plan to keep our two promises — both repealing Obamacare and replacing it with a system that provides affordable and portable health insurance — seems like a no-brainer to this gym rat,” Sasse wrote in a letter to the president he made public Friday.


Trump echoed the idea in a tweet arriving just moments after Sasse discussed the idea Friday morning on the “Fox & Friends” morning news show.

“If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” Trump tweeted.

The turn of events alarmed many in Washington because it was a reversal of Trump’s early view to do the Obamacare overhaul all at once.

Some predicted Trump’s move would only further complicate negotiations over the current Senate bill, which failed to garner enough support this week for a planned vote.

But other Senate Republicans expressed interest, desperate to find a Plan B that doesn’t preserve Obamacare’s taxes on the rich or cater to centrist senators trying to fend off deep Medicaid cuts. They also want to avoid turning to Democrats for help.

Senators left town for the long Fourth of July recess without agreement on the legislation drafted by Senate Majority Leader Mitch McConnell, the Better Care Reconciliation Act, which falls short of a full Obamacare repeal. Instead, the bill ends Obamacare’s taxes and mandates — giving tax breaks to the wealthiest Americans — while leaving 23 million more Americans uninsured, according to the nonpartisan Congressional Budget Office.

McConnell was working the phones Friday from his home state of Kentucky as he struggles to secure 50 votes for passage, rewriting the bill to address concerns of conservatives who want a more robust repeal, and centrists worried that constituents will lose their healthcare coverage.

Whether the Trump-Sasse idea, which has also been backed by another key conservative, Sen. Rand Paul of Kentucky, gains traction remains to be seen.

The president and the Nebraska senator are unlikely allies in part because Sasse — who did not endorse Trump — has been among the president’s most vocal GOP critics in the Senate.

But as Republicans seek a resolution to the Senate standoff, the proposal may have appeal. It would allow senators to make good on their repeal promise, while punting until later the tough job of coming up with a replacement.

Sasse suggests allowing a full year before the Obamacare repeal takes effect, but working through the August recess on fixes.

“I’d be fine with that,” Sen. Pat Toomey (R-Pa.) said Friday on Fox, though he doubted the proposal would have enough votes for passage. “What we would do is have the repeal go into effect at some date in the future, and give us the time in the meantime to develop the alternative.”

In reality, however, it’s possible — perhaps even likely — that Congress would never agree on a replacement. That risks abandoning 22 million Americans who have received health coverage thanks to Obamacare, including many who voted for Trump. It could also create even more disruption in the individual insurance market and lead to a return of high-priced polices as well as discrimination against people with preexisting health problems.

For those reasons, many centrist Republicans find the idea as troubling as the current Senate bill.

Perhaps more than a viable strategy, the new proposal may be intended as a signal to Republican senators that time is narrowing to reach a deal.

McConnell said as much last week, warning senators he would have no choice but to reach out to Democrats for a bipartisan deal that would likely “include none of the reforms we would like to make.”

Getting the healthcare issue off the agenda would also free up time for the other main Republican priority — tax reform — which has stalled amid the Senate’s logjam, and is also a Koch network priority.

Political strategists at the Koch network — a conglomerate of small-government advocacy groups — lauded Sasse’s approach, which largely aligns with what they have been promoting in a position paper issued in January.

“While we are continuing to work with the Senate to help improve their current legislation, the two-step repeal and reform approach that Senators Paul and Sasse have proposed would put Congress and the administration in the position to keep their promise and deliver that relief,” said Nathan Nascimento, a vice president at the Koch-backed Freedom Partners chamber of commerce, in a statement. The group first posted its idea in January. “The best way to provide relief to Americans suffering under Obamacare has always been to fully repeal Obamacare and work together to fix our broken health care system.”

It wouldn’t be the first time the Koch network has provided a legislative road map to Republicans in Congress in the Trump administration.

Freedom Partners encouraged Congress to use the little-known Congressional Review Act to rollback more than a dozen Obama-era regulations – even helping to compile the list -- which Republicans now count as one of the chief achievements of this Congress.

Sasse’s office said the senator did not discuss the healthcare plan when he attended the Koch seminar last weekend in Colorado, where he delivered a lunchtime speech on Sunday.

But the senator has been working with the administration, including Vice President Mike Pence’s office, for months on the healthcare plan.

Pence met privately June 23 with billionaire Charles Koch ahead of the weekend seminar.

Trump had once panned the two-step approach, disagreeing with McConnell and other congressional leaders who early on also preferred the repeal now-replace later strategy.

When Sasse floated it anew, the administration signaled its support.



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