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Congress took its first steps toward reversing President Obama’s health-care reforms Thursday, but Republican leaders are coming under intense pressure from rank-and-file lawmakers to detail exactly how their “repeal and replace” plans will play out before moving any further.

The Senate voted early Thursday morning on a measure that would allow the use of the special budget reconciliation process to pass health-care legislation. That would allow Republicans to act without securing cooperation from Democrats, who have vowed to block major changes to the Affordable Care Act.

[Obamacare is one step closer to repeal after Senate advances budget resolution]

The measure is set for a House vote on Friday, but lawmakers across the GOP’s ideological divides have sounded anxious notes about moving forward with Obamacare’s repeal without firm plans for its replacement.

“We just want more specifics,” said Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus said Wednesday. “We need to know what we’re going to replace it with.”

Rep. Charles W. Dent (R-Pa.), chairman of the moderate Tuesday Group, said members of that caucus have “serious reservations” about starting the process without replacement plans spelled out. “We’d like to have this conversation prior to the repeal vote,” he said.

Neither group has taken a binding position against the procedural measure that will be voted on Friday. But their wariness has forced House GOP leaders to reassure jittery members that they won’t move precipitously, in a way that would open Republicans to charges that they threw the health-care system into chaos by repealing without fully replacing Obamacare.

“This will be a thoughtful, step-by-step process,” House Speaker Paul D. Ryan (R-Wis.) said Thursday. “We’re not going to swap one 2,700-page monstrosity for another. . . . We’re going to do this the right way.”

[Why Obamacare is unlikely to die a swift death]

The complication, however, has been President-elect Donald Trump, who this week made a series of sweeping statements about the timing and substance of his health care plans.

Replacement of Obamacare, he said at a Wednesday news conference, would happen “essentially simultaneously” as its repeal and would be “far less expensive and far better.” In a New York Times interview published Tuesday, Trump indicated that legislation could come together within weeks.

But several key lawmakers involved in drafting the health-care legislation indicated that is an overly ambitious timeline. Democrats took more than a year to pass the Affordable Care Act and ancillary legislation, and they had a filibuster-proof 60-vote Senate majority for much of that process.

“I guess it depends on how you define ‘simultaneous,’” said Rep. Michael Burgess (R-Texas), chairman of the Energy and Commerce Subcommittee on Health, when asked Wednesday about Trump’s comments.

Rep. Greg Walden (R-Ore.), chairman of the Energy and Commerce Committee, said, “There’s a lot of different timelines floating around.”

“I think there’s a lot of energy for getting on with both” repeal and replacement, he said. “The question is, what are the formalities for that? We want to have a due process here, we want to have a transparent process. We want to have a full legislative process.”

Another wild card is Trump’s pick for Health and Human Services secretary, Rep. Tom Price (R-Ga.). Trump suggested Wednesday that Price would play a key role in shaping the Obamacare replacement strategy.

“As soon as our secretary is approved and gets into the office, we’ll be filing a plan,” he said. It was unclear whether he meant a legislative plan, or a plan for repealing or modifying Obamacare-related regulations.

House leaders see Price, the House Budget Committee chair and an orthopedist, as a reliable partner. But it is unclear how quickly he might be confirmed. The Senate Finance Committee has yet to set confirmation hearings, and Democrats are pledged to undertake a no-holds-barred blitz on Price’s record given the influence he will wield over government health-care programs.

“It’s really important to get Dr. Price in as secretary,” said Rep. Patrick J. Tiberi (R-Ohio), chairman of the Ways and Means Subcommittee on Health. “That’s going to be key to working with us, and we obviously know a lot about what he thinks about.”

Ryan said Thursday that he and Trump are “completely in sync” on health care and suggested that more details would be on offer at the yearly congressional Republican retreat, which will be held in Philadelphia the week after Trump’s inauguration. Trump is scheduled to address lawmakers there.

“We’re going to have a full, exhausting conversation at our retreat to go through all of these things,” Ryan said Thursday. “What I think people are beginning to appreciate is, we have lots of tools in front of us. It’s not just a one-and-done-bill kind of a thing. And so that’s what we’ve been walking our members through, are all the options available to us to get this done.”

One of the those tools is budget reconciliation, he said — a process that will kick off once the House passes the legislation that cleared the Senate Thursday morning.

That will pave the way for Republicans to pass a bill gutting major parts of the Affordable Care Act, including the system of tax subsidies and penalties that Democrats relied on to increase coverage levels.

Trump spokesman Sean Spicer told reporters Thursday that the Senate vote was “a huge step in the right direction.”

GOP leaders are taking a close look at what elements of a replacement plan can be included in the forthcoming Obamacare repeal bill set to be passed under reconciliation. But Senate rules dictate that only measures with a discrete budgetary impact can use those procedures.

So while Republicans could claim that the bill repealing Obamacare also contains a blueprint for its replacement, other parts of the replacement would need 60 Senate votes — and thus significant Democratic support.

According to multiple GOP sources, Republicans are looking at whether to use upcoming reauthorizations of existing programs, such as the Children’s Health Insurance Program, as vehicles for Obamacare replacement measures. That could give them leverage to secure cooperation from Democrats.

Behind the scenes, GOP leaders are urging lawmakers to look at this week’s votes as mere procedural formalities. But some rank-and-file members remain nervous about voting to start a process they might not be able to stop.

“I told my members, in order to have a meaningful impact . . . you better speak up now,” Dent said.

Kelsey Snell contributed to this report.

Read more at PowerPost

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