WASHINGTON – Yes, Donald Trump is taking charge and Republicans control both the House and Senate, having won an election promising to repeal President Barack Obama's health care law.
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But in Congress, getting from Point A to point B rarely consists of a straight line, and Democrats in the Senate can easily gum up the works with procedural blockades. Since Republicans hold the Senate with just 52 votes, they are forced to employ an arcane, fast-track budget process to avoid a Democratic filibuster.
With those advantages come a host of complications, however, most particularly restrictions on the range of provisions that can be passed under fast-track rules.
Separately, several Senate Republicans are expressing reservations about repealing without a viable alternative. Majority Leader Mitch McConnell, R-Ky., said they will move quickly to replace it, but failed to provide a specific timeline.
WHAT'S THE FIRST STEP?
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Pass a non-binding budget blueprint for the current 2017 fiscal year, and it's already started in the Senate. The budget plan is mainly illustrative, but its passage permits binding follow-up legislation to actually repeal the 2010 health care law. Both the budget and the follow-up "reconciliation" bill can pass the Senate by a simple majority vote after limited debate. Both measures are subject to unlimited amendments, which are invariably stacked until the end and result in an hours-long series of votes that typically stretch until after midnight.
On Capitol Hill, the process is dubbed "vote-a-rama."
Usually budget resolutions make projections about spending and taxes. The current measure is a "shell" bill that projects almost $10 trillion in new debt over a decade, but enabling action on repeal. Sen. Rand Paul, R-Ky., a strong fiscal conservative, has railed against fellow Republicans about adding to the debt.
AND THE ACTUAL REPEAL BILL?
The ensuing repeal legislation — a budget "reconciliation" bill in Washington-speak — would be written by a handful of House and Senate committees with jurisdiction over health issues. It'll first go to the House, where debate should be fairly routine. When the Senate takes up its version, however, Democrats will have many opportunities to offer amendments. The House and Senate would have to work out their differences before passing a final version and sending it to the White House for Trump's signature.
THAT SOUNDS SIMPLE ENOUGH, BUT ...
Well, there's a major complication. Reconciliation bills operate under special rules, the most important of which is that its provisions need to have an impact on the budget or else they can be scuttled for being extraneous. This is a huge issue in the case of "Obamacare," since some pieces of the law, such as mandating that insurance companies cover people with pre-existing medical conditions, can't be modified in a fast-track reconciliation measure.
For instance, Republicans want to eliminate the requirement that individuals buy insurance. But that could mean too many people who are sick or have pre-existing maladies sign up, while healthier people stay away from the health insurance plans that are available on the law's state exchanges. That could make the entire system collapse. So using the budget process to repeal most, but not all, of Obama's health law is an imperfect tool at best.
WHAT ABOUT REPLACING THE LAW?
That's even trickier. It would require the process to start all over again with an entirely new budget resolution — at least for any legislation that wouldn't need Democratic support. But this one would be far more difficult because Republicans would have to agree on controversial budget matters as well.
Or, Republicans could seek Democratic help and try to pass replacement legislation with a bipartisan coalition. That looks tough at this point, however.
WHAT ABOUT PRESIDENT-ELECT TRUMP?
Trump and his chosen secretary of Health and Human Services, Rep. Tom Price, R-Ga., have broad executive branch powers under the law. The Trump team promises to use them to undo whatever Obama policies they can but also to try to smooth the transition for insurance markets that may struggle in the aftermath of Obamacare's repeal.