Here’s How Congress Could Repeal Or Replace Obamacare

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President-elect Donald Trump and the Republicans who control Congress say “repealing and replacing” Obamacare is their top legislative priority.

Republicans can repeal significant portions through a budget procedure that avoids a Senate filibuster and allows them to pass it on a party-line vote. But they cannot repeal all of it that way.

And if they want to replace Obamacare, that’s even harder. They will need 60 votes (and Democratic support) to overcome a filibuster.

So it may be listed as a “100 days” priority, but it’s complicated and likely to take several months. Even if they can get Democratic support, passing a replacement bill could take up two years, aides say.

That’s because the GOP doesn’t have the 60-seat supermajority in the Senate needed to overcome a filibuster that Democrats plan to launch against the repeal effort. In January, when the new Congress starts, Republicans may hold as many as 52 seats.

To get around that blockade, Republicans could use a process called “budget reconciliation,” which would allow the Senate to dismantle large chunks, but not the entire law with just 51 Senate votes. Those sections are related to taxes and spending — such as subsidies to buy health insurance, tax credits, penalties for not having insurance, and the expansion of Medicaid.

But Republicans would still need 60 votes to get rid of remaining sections of the law — including popular provisions such as allowing young people to stay on their parents’ health insurance until age 26 and preventing insurance companies from not covering people with pre-existing conditions.

That means Republicans would need to get support from at least eight Democrats to make changes to those provisions. Democratic leaders say they won’t engage in negotiations that would undermine the law, although they say they would be open to talks to improve it.

But Republicans believe they might be able to persuade some moderate Democrats — especially those running for re-election in 2018 in more conservative states — to possibly vote for their proposals.

Either way, nothing is expected to happen until probably the spring of 2017. That’s because both the House and Senate need to both pass the same budget resolution bill before they can use the special 51-vote procedure and that should take a few months.

In addition, Republicans say their repeal language could provide a window of about two years to give them time to “replace” what they are repealing. That is a reflection that negotiating the changes with Democrats could be time-consuming.