washington<u+2014>ascendant republicans who have put a repeal of the affordable care act at the top of their to-do list face a set of early, key decisions that will test the party<u+2019>s consensus on the issue. among them: how much of the 2010 health law to strike early on, how soon and how closely to work with democrats in shaping a replacement, and how much leeway to give consumers who might be caught without coverage in between a repeal and a new law. lawmakers who weren<u+2019>t necessarily expecting donald trump to win the presidency now see they can move ahead more boldly on the health law than they anticipated. <u+201c>vegas didn<u+2019>t give us good betting odds,<u+201d> said gop rep. mark meadows of north carolina, where the insurance market has become troubled under the law but where major revisions to it would cause disruptions for many insured people. for the 238 or more republicans in the house and 51 or more in the senate who take office in january, the first fight will come soon, with a budget measure to be taken up in early 2017. senate republicans could make significant changes to the health law through budget moves without requiring the usual 60-vote majority to break a filibuster. the rhetoric so far suggests they want to go all in with the budget maneuver, known as <u+201c>reconciliation,<u+201d> to repeal as much of the law as possible. but in a dry-run of the tactic last year, some gop lawmakers appeared to hold back. the house passed an early version of a measure that voided the law<u+2019>s requirements for individuals to obtain coverage and for employers to offer it or pay penalties. but it left many other parts intact, including tax credits for people to buy coverage and funding for states to maintain expanded eligibility for medicaid. ultimately, a threatened revolt in the senate by mike lee of utah, marco rubio of florida and ted cruz of texas forced an expansion of the effort. but the initial move showed that under some circumstances, there is sentiment within the republican caucus for a more cautious approach. both chambers then agreed to the broader package , which was vetoed by president barack obama. voices urging caution may carry more weight this year because republicans have said they want to have bipartisan support as they tackle their pledge to repeal the law and ensure it gets a timely replacement. at the same time, those lawmakers can expect to find their feet held to the fire if they try to go back on their vote. <u+201c>some lawmakers likely supported repeal in theory<u+2014>not expecting it would ever get put into practice,<u+201d> said health-policy analyst chris jacobs, who as a staffer advised conservative republicans on capitol hill. <u+201c>conservatives successfully fought last year to expand the scope of the reconciliation measure considered by congress<u+2014>a bill that was ultimately supported by the overwhelming majority of republicans in both chambers. for that reason, that legislation should serve as the minimum baseline for repeal efforts in the coming year.<u+201d> the outcome of this early skirmish will also indicate how much republicans will work with democrats in resolving questions over the rest of the law<u+2019>s fate. gop members, even those aggressively pursuing a repeal, have said they need democratic support to pass substantive replacement legislation through the senate. <u+201c>both parties will have input,<u+201d> said avik roy, a health-policy expert who advised mr. rubio during his presidential campaign. <u+201c>the aca stalling out and the need for 60 votes in the senate creates a discussion.<u+201d> another significant test will be determining how to handle people with existing medical conditions, currently guaranteed a right to buy insurance at the same prices as anyone else under the health law. mr. trump has indicated interest in retaining that provision, though doing so absent other provisions would create problems in the individual insurance market that would have to be addressed. house republican chairmen had largely formulated their own set of ideas before mr. trump<u+2019>s election, saying they would guarantee insurers couldn<u+2019>t rescind coverage for people simply because they fall sick and must cover them on the same terms as anyone else only if people could show they had maintained continuous coverage. their plan would also likely restore funding for state-run insurance pools for people with heftier medical needs. supporters of the health law have already signaled they don<u+2019>t consider house gop plans to be a replacement for the law<u+2019>s sweeping requirement that insurers sell coverage at the same prices to all, regardless of their medical history, with limited variation based on age. republicans, should they repeal the law, would also have to wrestle with the details of a transition period for people who currently have tax credit-subsidized private coverage. such a transition has been pledged by vice president-elect mike pence, but the time frame will likely be set in congress. in previous runs at overturning the law, republicans have tussled over whether a transition period represented a weakening of resolve to strike the law or a necessary compromise to avoid harming constituents. they have generally settled on an 18-month window, but depending on when that started, it could run immediately into the path of the next round of elections. <u+201c>they could repeal the law but keep subsidies to expire at the end of 2019,<u+201d> said mr. roy. some observers believe lawmakers won<u+2019>t position themselves until they have firmer signals about personnel in a trump administration. <u+201c>coalescing will have to wait until the trump team has a health-care team in place,<u+201d> said paul howard, a senior fellow at the conservative manhattan institute. <u+201c>it<u+2019>s going to be a big lift, a complicated lift, and you<u+2019>re going to have to have the white house deeply involved in strategy.<u+201d> write to louise radnofsky at louise.radnofsky@wsj.com and stephanie armour at stephanie.armour@wsj.com
on republicans<u+2019> path to health-law repeal, questions emerge - wsj
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