The American health care system is not like a normal market. When you make most health care decisions, you don’t get much information on comparative cost and quality; the personal bill you get is only vaguely related to the services; the expense is often determined by how many procedures are done, not whether the problem is fixed. Republicans are going to try to introduce more normal market incentives into the process. They will likely rely on refundable tax credits and health savings accounts to ensure that everybody can afford to shop for their own insurance and care.

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The House voted Friday on the measure that passed the Senate, part of a process that will make it easier for a subsequent Obamacare repeal bill to advance through the Senate with a simple majority vote and without the threat of a Democratic filibuster. The budget resolution is a crucial first step for Republicans controlling Congress to keep their longstanding promise to repeal the law, which is saddled with problems such as rapidly rising premiums.

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A growing number of Republicans are balking at the prospect of repealing the ACA so quickly without a firm plan to replace it. Now with the Senate on a path to eliminate the ACA, some Republicans are worried about the political fallout and uncertainty of starting to roll back the law without knowing how the process will end. Conversations with Republican senators and a review of their statements show that nearly a dozen have publicly expressed some level of concern about repealing the law without a replacement. “There are a lot of people that have concerns about doing a repeal with no replacement or at least some guidance on replacement,” said Sen. Bob Corker (R-TN) who has co-sponsored language to delay the nonbinding deadline for repeal legislation until March 3. “The train leaving the station this week is not a big event, it’s when the train pulls back into the station that’s the big event,” Corker explained.

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Industries that were integral to the creation of the ACA are keeping their voices down as Republicans quickly dismantle it. The speed of Republican efforts to repeal the ACA has stunned health industry lobbyists, leaving representatives of insurance companies, hospitals, doctors and pharmaceutical makers struggling for a response to a legislative quick strike that would upend much of the American health care system. Given that repeal is forthcoming, the health care industry is staying relatively silent on the binary question of repeal, but is expected to get more heavily involved on the nature and details of replace.

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While the budget passed early this morning won’t be signed into law, it must be approved by both chambers for committees to begin drafting reconciliation legislation. Reconciliation is one of the most powerful weapons in the majority’s procedural arsenal. Under reconciliation, bills are protected from the 60-vote filibuster so they can be passed through the Senate and House by a simple majority. Democrats used it to finish passing the ACA seven years ago, and now Republicans intend to return the favor to dismantle the law. There’s a hitch, though: Under budget reconciliation, only provisions that affect federal spending or taxes can be targeted. That means Republicans cannot completely eliminate or replace the law in one fell swoop. The final call on what can or cannot be addressed in a reconciliation bill will be made by the Senate parliamentarian. The GOP did a dry-run in the last Congress, passing a reconciliation bill that killed key parts of the ACA, including the individual mandate, insurance subsidies for consumers and the Medicaid expansion. President Obama vetoed the legislation, but that won’t be an issue this time around with Trump in the White House.

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The House Freedom Caucus decided Wednesday afternoon not to take an official position on the House budget, freeing up their members to vote however they want on a resolution crucial to repealing Obamacare, according to a source familiar with their deliberations.

The budget is largely a procedural measure, but sets up a framework to repeal the health care law while avoiding a Senate filibuster. Conservatives in the Freedom Caucus have been pressing leadership to detail how they plan to replace the law before agreeing to go ahead with the budget vote.

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After eight years Republicans are finally in a position to repeal the Affordable Care Act.  Many caution that repeal without concomitant replacement will lead to chaos in the insurance markets with millions losing coverage.  These fears are overstated. Yet replacement should accompany repeal for another reason – to maximize the chance that a good replacement package can be enacted.

Republicans hold 52 Senate seats.  While a repeal of much, but not all, of the ACA can occur with a simple majority vote through the reconciliation process for items with budgetary implications, repealing the entire law and enacting a replacement will require 60 votes. Republicans need help from at least eight Democrats.  They have the best chance of getting it if they combine repeal with a comprehensive replacement package that includes individual items that appeal to specific Democrats who will, therefore, be willing to vote for the entire package.

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Even as senators began grinding through a budget resolution that sets up a repeal of the 2010 health care law, the timeline for striking President Barack Obama’s biggest legislative legacy appeared to be slipping.

President-elect Donald Trump said at a news conference Wednesday in New York City that a plan to replace the Affordable Care Act would come once Secretary of Health and Human Services nominee Rep. Tom Price of Georgia wins confirmation.

But the chairman of a key committee involved in both the repeal-replace process and in confirming Price said his confirmation may not take place until around the President’s Day recess in February.- See more at: http://www.rollcall.com/news/policy/tom-price-might-not-confirmed-mid-february-says-key-senator#sthash.BSsYaVfW.dpuf

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The Senate voted 51-48 early this morning to advance a budget resolution starting the process of repealing the Affordable Care Act, with only Sen. Rand Paul (R-KY) crossing party lines. Democrats forced roughly seven hours of mostly symbolic votes, and GOP senators withdrew an amendment that would have formally given more time to lawmakers crafting forthcoming reconciliation legislation that would repeal the law. Senate Minority Leader Chuck Schumer (D-NY) said yesterday that Democrats intend to ensure that Republicans are held responsible for any chaos caused by ending the ACA. “Put this irresponsible and rushed repeal plan aside,” ­Schumer said on the Senate floor. “Work with us Democrats on a way to improve health care in America, not put chaos in place of affordable care.” In his news conference yesterday, President-elect Donald Trump insisted that repeal would not occur without a replacement plan. “Obamacare is the Democrats’ problem. We’re going to take the problem off the shelves for them. We’re doing them a tremendous favor,” Trump said.

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Republicans have been winning elections for years by promising to repeal and replace the Affordable Care Act. Now that the dog has caught the car, we have to know what to do with it. Republicans have captured the White House, and kept the House, Senate and a majority of the governors’ offices. There are no more excuses, and voters are rightfully expecting quick and bold action.

Already, though, the media is beginning to highlight or perhaps even create differences among the Republican victors, with stories about some in the party wanting a quicker timeline for repeal than others. Before we get bogged down by a debate about whether Obamacare should be repealed within two or three years (and I am for sooner than later), it would be helpful to remember why conservatives have opposed Barack Obama’s health law so vehemently. And no, despite the president’s protests, it is not simply because of the name. Articulating our principled objections will help inform how Republicans should replace this flawed legislation.

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