Paul Ryan, under growing pressure, advocates simultaneous Obamacare 'repeal and replace'

Paul Ryan, under growing pressure, advocates simultaneous Obamacare 'repeal and replace'

By Deirdre Walsh and MJ Lee, CNN

Updated 1:19 PM ET, Tue January 10, 2017

Washington (CNN) - Under mounting pressure from Republicans about forging ahead with repealing Obamacare without a replacement plan, House Speaker Paul Ryan said Tuesday that GOP leadership now hopes to tackle "repeal and replace" simultaneously — a dramatic turn of events from the original goal of quickly repealing the healthcare law.

"It is our goal to bring it all together concurrently," Ryan told reporters after a closed-door meeting with House GOP members.

Ryan emphasized that it would be a complicated and multi-pronged effort. "We'll use every tool at our disposal through legislation, through regulation, to bring replace concurrent along with repeal so we can save people from this mess," Ryan said.

Republicans on Capitol Hill are united on getting rid of President Barack Obama's signature healthcare law. The House and Senate are expected to vote this week on a budget resolution -- dubbed by Republicans as the "repeal resolution" -- that will be the first of two steps in rolling back major parts of Obamacare, also known as the Affordable Care Act. But Ryan's statement and concerns from other key lawmakers means the final vote won't happen soon.

Republicans came back to Washington with a plan to quickly repeal the law while working on a replacement, but as they confront the practical impact of wiping away much of the current health care system, Republicans are also anxious to quickly reassure the public that they have a plan for what would come in its place. They also have clear marching orders from President-elect Donald Trump, who has expressed his clear preference for acting on repeal and replace at the same time.

With the budget resolution vote just days away, alarm bells are ringing out across Capitol Hill.

Senate Republicans have grown increasingly vocal, airing concerns that the party may be moving too fast to repeal a law that covers some 20 million people; in the House, GOP members ranging from conservatives to moderates are also joining in.

These worries spilled out into the open during a Tuesday morning House GOP conference meeting, where members shared their unease about the upcoming budget resolution vote.

Rep. Mark Meadows, the chairman of the conservative House Freedom Caucus, said the group will not take an official position on the vote until they get more reassurances from leadership.

"We just would like some more specifics in terms of repeal and replacement aspects of the Affordable Care Act, where we're going with it," Meadows said as he left the GOP conference meeting. "Hopefully, what we will see and we're hopeful that leadership will give us some more specifics in the next 24 to 48 hours."

"I ran for office on repeal and replace. I certainly think we should advance replacement aspects as quickly as possible," New Jersey Republican Rep. Leonard Lance told CNN.

Lance said he was willing to support the procedural steps to begin unwinding the law but stressed that he wants a clear timeline for those covered under Obamcare's Medicaid expansion so patients know where to get coverage under a new program.

Kentucky Rep. Andy Barr suggested that there were tensions in Tuesday's meeting between members who were emphatic that a repeal and replace vote happen simultaneously, and others who stressed that it's simply impossible to move toward repeal until the Republicans first pass the budget resolution.

"There's some folks who have expressed a desire to do everything at once but I don't think they fully understand that if we don't take these first steps, we're never going to get to the next step," said Barr, a member of the Republican Study Committee, which introduced its own replacement plan last week.

Barr said he will vote in support of the budget resolution and that he expects a "very large majority" of his conference to do the same.

Ryan and other leaders discussed ideas for adding replacement into an upcoming budget reconciliation bill -- the vehicle through which Republicans plan to roll back Obamacare. But the speaker admitted that they haven't decided yet how much of the law they can dismantle or replace with this approach, pointing out that there are rules limiting what the budget reconciliation bill can include.

"We will pass as much as we can through whatever vehicle we've got and then we will pass all the other things through regular order outside of reconciliation that show you the full scope of what a real replacement effort will look like," Ryan said.

Florida GOP Rep. Dennis Ross told reporters that the hope is to "do as much replacement as we can get away with in the reconciliation package" before throwing the ball back to the Senate.

He said Republicans will focus on measures related to tax and spending, including provisions to promote health savings accounts, remove the financial penalty for those who don't enroll in Obamacare.

Republican leaders also continue to insist there will be a smooth transition to a new system and that they won't abruptly cancel insurance policies.

House GOP Conference Chair Cathy McMorris Rodgers took those reassurances one step further on Tuesday, saying: "Let me be clear: no one who has coverage because of Obamacare today will lose that coverage."

Others stressed the need to begin the process now to repeal the law, but seemed comfortable with allotting plenty of time for the rest of the process to play out.

"There is a recognition that Obamacare took a long time to construct," Illinois Republican Rep. Peter Roskam said, "and it's similarly going to take a long time to deconstruct."