President Donald Trump has called on GOP lawmakers to enact a full repeal of the Affordable Care Act, commonly known as "Obamacare," if they cannot negotiate enough votes to pass their own health care bill.
On June 30, Trump took to social media to urge Republican senators to repeal the ACA outright if they could not garner enough votes to pass the proposed Better Care Reconciliation Act after returning from their July 4 recess.
"If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!" the president tweeted.
In 2015, Senate Republicans passed a full repeal of the ACA through budget reconciliation, a process that bypassed the chamber's requirement of 60 votes. Trump's latest announcement was partly prompted by a letter penned by Republican Sen. Ben Sasse of Nebraska the same day.
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"On July 10, if we don't have agreement on a combined repeal and replace plan, we should immediately vote again on... the December 2015 ObamaCare repeal legislation that the Congress passed but President Obama vetoed," Sasse wrote, according to CNN. "We should include a year-long implementation delay to give comfort to Americans currently on ObamaCare that a replacement plan will be enacted before expiration."
Trump had previously pledged that he would not sign legislation to repeal the ACA before there was an immediate replacement. In November 2016, the president said any repeal would be coupled with replacement.
"No, we're going to do it simultaneously... We're not going to have, like, a two-day period and we're not going to have a two-year period where there's nothing," Trump told CBS News. "It will be repealed and replaced. And we'll know. And it'll be great health care for much less money."
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Trump later wavered on his original pledge and suggested GOP lawmakers might repeal the ACA first and worry about a replacement plan later. On Jan. 10, Republican Sen. Rand Paul of Kentucky convinced the president that a simultaneous repeal and replacement plan was necessary, according to Vice News.
"I just spoke to [Trump] and he fully supports my plan to replace Obamacare the same day we repeal it," Paul tweeted out. The time to act is now."
Nearly six months later, Paul is now supportive of Trump's call to repeal immediately and replace later.
"I have spoken to [Trump] & Senate leadership about this and agree," Paul tweeted out on June 30. "Let's keep our word to repeal then work on replacing right away."
The Senate Majority Leader, Republican Sen. Mitch McConnell of Kentucky, had aimed to pass the BCRA before Congress' July 4 recess. On June 27, McConnell announced that he would delay the vote until after the recess amid several Republicans publicly stating they would not support the legislation. The decision arrived a day after the Congressional Budget Office estimated the BCRA would result in 22 million Americans without access to health insurance by 2026, The New York Times reports.
In 2015, when Republicans first voted on a full repeal of the ACA through budget reconciliation, the CBO found that completely uprooting the health care law would result in 18 million Americans losing health insurance within the first year of implementation. That number would grow to 26 million soon after, according to Politico.
It is unclear whether or not GOP lawmakers would support a full repeal of the ACA without an immediate replacement.
"Not going to happen," one senior GOP aide told Axios. "15 votes for that strategy. Which is why we are where we are."
"I think it's repeal and replace," Republican Rep. Adam Kinzinger of Illinois said. "We can argue whether they like the system we're bringing them in or not, but simply a repeal, even with the sunset the year or two down the road... You can't leave the American people out like this."