washington<u+2014>republicans on capitol hill are grappling with the likelihood that they will need democratic support to pass parts of any plan replacing the affordable care act, setting up a complex legislative battle over the law<u+2019>s future. president-elect donald trump is expected in his first days in office to take executive action voiding parts of the health law that the administration has discretion to change. soon after that, lawmakers likely would start on their efforts to repeal and replace the law. with full control of congress and the white house, republicans have anticipated being able to repeal the law using a special budget maneuver that would allow them to get around a filibuster by democrats in the senate. but to replace it, they likely would need the support from eight democrats and all 52 republicans in the senate (if republican john kennedy wins a dec. 10 runoff in louisiana) to reach the 60 votes needed to clear the chamber<u+2019>s procedural hurdles. <u+201c>who will the eight or nine democrats be? it will be a pretty drawn-out process,<u+201d> said avik roy, a health policy expert who advised republican senator marco rubio during his presidential campaign. <u+201c>what do they need to be happy?<u+201d> part of the calculus is whether congress would enact a repeal without having a replacement in hand<u+2014>or at least the votes in hand for a replacement. lawmakers said they are likely to include a transition period phasing out the law when they repeal it. republicans think that could help put pressure on democrats to support a replacement. <u+201c>once it<u+2019>s repealed, you will have fewer people playing politics<u+201d> on the health-law, house majority leader kevin mccarthy (r., calif.) told reporters tuesday. the obama administration says provisions in the aca have led to more than 20 million people gaining health care coverage. a large number are lower-income people who have been covered through medicaid expansions in 31 states and the district of columbia. it<u+2019>s unclear what would happen under various repeal and replacement scenarios, although democrats and health policy experts have said most proposals would mean millions of people would lose coverage and become uninsured. <u+201c>when they get down to the real world of writing this bill, they<u+2019>re going to find some real challenges,<u+201d> said sen. dick durbin (d., ill.) some republicans and health-policy advisers say they believe some senate democrats could be drawn into negotiations if the talks include issues they care about such as rising drug prices and high out-of-pocket health-care costs affecting the middle class. a transition period could stretch into 2019, allowing time for lengthy negotiations. <u+201c>we continue to talk with the [trump] transition team about the agenda for next year, including repeal and replace,<u+201d> said ashlee strong, a spokeswoman for house speaker paul ryan. but counting on bipartisan support is risky. democrats, who have shouldered responsibility for the flaws of the affordable care act for years, may not be eager to take ownership for its next version, written by republicans. <u+201c>they haven<u+2019>t proposed anything that i could support so far,<u+201d> said sen. bob casey, a pennsylvania democrat up for re-election in 2018. <u+201c>we<u+2019>ll see what happens.<u+201d> sen. angus king of maine, an independent who caucuses with the democrats, said he didn<u+2019>t see how republicans could square their desire to keep the health law<u+2019>s most popular provisions, including guaranteeing coverage for people with pre-existing conditions, without the requirement that individuals obtain health insurance. <u+201c>if you don<u+2018>t have some kind of mandatory coverage or personal mandate, nobody will get health insurance until they<u+2019>re on the way to the hospital in the ambulance,<u+201d> mr. king said. <u+201c>what i<u+2019>ve heard so far doesn<u+2019>t hold together as a replacement plan.<u+201d> some democrats expressed less skepticism of a gop replacement plan. <u+201c>i would like to see what they propose,<u+201d> said sen. joe manchin of west virginia, a centrist democrat up for re-election in 2018, <u+201c>i<u+2019>m amicable to anything if it makes sense. if i can<u+2019>t got home and explain it, i can<u+2019>t vote for it.<u+201d> sen. john thune of south dakota, a member of senate gop leadership, said republicans are still investigating what they can clear through the chamber with the special budget shortcut known as reconciliation, which has complex rules restricting its use, and what would require 60 votes. he said he expected certain components would need bipartisan support. house and senate republicans would also have to work out differences they have between replacement ideas, hill staffers said. those discussions are still in their early stages. mr. trump<u+2019>s nomination tuesday of rep. tom price of georgia to head health and human services department reflects the gop drive to topple the health law quickly. mr. price, a physician, has for years developed plans to replace the law. mr. trump<u+2019>s transition team, in announcing mr. price<u+2019>s nomination to head hhs tuesday, said they hoped to take executive action to topple parts of the law <u+201c>as soon as day one.<u+201d> senate republicans have been less specific about their plan for overhauling the health-care law. senate majority leader mitch mcconnell (r., ky.) told reporters tuesday that in early january, senate republicans will <u+201c>begin the opportunity for repeal and replace<u+201d> of the law. <u+2014>damian paletta contributed to this article. write to stephanie armour at stephanie.armour@wsj.com , kristina peterson at kristina.peterson@wsj.com and louise radnofsky at louise.radnofsky@wsj.com
getting obamacare replacement through senate will be a test - wsj
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