WASHINGTON: Republican leaders and the White House presented a united front on Friday in their bid to ditch Obamacare, but the replacement plan — still incomplete, still hidden from public view — is meeting increasing pushback from rank-and-file conservatives.

With Democrats of a single mind to keep the landmark health-care reforms in place, US President Donald Trump and House Speaker Paul Ryan can ill afford an open revolt within the very party that has waged war on the Affordable Care Act (ACA) for the past seven years.

But as public support for the law grows, and several Republican governors who expanded the low-income Medicaid programme through Obamacare warn that the plan could leave their state budgets underwater, Republican leaders find themselves in a pickle over how to proceed.

Trump laid out a framework for his “repeal-and-replace” plan during his maiden speech before Congress on Tuesday, when he expressed support for Ryan’s call to use tax credits to help Americans purchase their own health-insurance coverage once Obamacare is dead and buried.

That did not sit well with several GOP conservatives like Senator Rand Paul, who said tax credits are just a reworked version of the ACA’s existing subsidies.

“I don’t think we can dress up Democrat ideas and put a Republican stamp on them,” he said.

Republicans base their reforms on several objectives: increasing competition, reducing cost and expanding choices in part by allowing insurance purchases across state lines.

But they also must contend with inconvenient truths about the law. An additional 20 million more Americans are now covered under Obamacare, and insurance companies are barred from refusing coverage to people due to pre-existing conditions. Children can also now remain on their parents’ plan until age 26.

Trump has said he wants an orderly transition to ensure no one gets bumped off coverage, and that the provision on pre-existing conditions be kept part of any new law.

The plan’s crafters must find ways to meet those challenges, while scrapping the so-called individual mandate requiring people to buy health insurance — a key element that was intended to help cover those costs.

A recent, leaked version of the plan was not received well by Paul and other conservatives, including Mark Meadows, who heads the House of Representatives’ far-right Freedom Caucus and said he would vote against anything but full repeal.

Congressman Mark Walker, chairman of the House’s Republican Study Committee, also announced his opposition.

Paul was a chief actor in an almost comical hide-and-seek sideshow on Thursday on Capitol Hill, where lawmakers from both parties sought to get a glimpse of the latest iteration of the repeal-and-replace legislation.

He roamed the halls with a photocopy machine in tow looking for the “secret” location where Republicans were reviewing what he called “the Obamacare Lite bill.”

Finishing touches?

Two powerful panels, the House Energy and Commerce Committee and House Ways and Means Committee, reportedly will review and vote on the plan in the coming week, as teams of aides and lawmakers have struggled to come together on a bill that can assuage conservative concerns and pass muster in both chambers of Congress.

With the battle over health care coming to a head, and Trump eager for a legislative victory, Vice President Mike Pence travelled to Wisconsin with Ryan and Health and Human Services Secretary Tom Price to rally public support.

“We’re putting the finishing touches on our plan even as this weekend rolls out,” Pence insisted as he touted the health overhaul to workers at Blain’s Farm & Fleet in Ryan’s hometown of Janesville. “The Obamacare nightmare is about to end.”

There is intense pressure on Republicans to make good on their promise to bury the ACA.

But Paul and fellow senators Ted Cruz and Mike Lee are calling on Congress not to pass the contentious new plan, but to use the language of a 2015 bill that repealed most of the ACA but was vetoed by then-Democratic president Barack Obama.

Together they carry weight — Republicans have just a two-seat majority in the Senate, so if the trio jumps ship they could kill any bill they oppose.

“They don’t have the votes,” top House Democrat Nancy Pelosi said on Friday of the Republican health-care initiative.

The issue was front and centre as constituents at recent fiery town hall meetings voiced concerns to their lawmakers about how millions of Americans could lose their coverage.

The latest Kaiser Family Foundation tracking poll shows Obamacare at its highest favourability rating since 2010, with 48 per cent of respondents viewing it favourably versus 42 per cent unfavourably.

A separate poll by the Pew Research Center found that support for Obamacare surged in 2017 and reached an all-time high of 54 per cent in February, while 43 per cent disapproved.

Published in Dawn, March 5th, 2017