GOP lawmakers grope for consensus on remaking health law

House Republican leaders sketched broad outlines of a replacement for President Barack Obama's health care law that left rank-and-file GOP members at odds and questioning details and timing of how the GOP intends to deliver on its long-promised alternative.

"Unrealistic may be a strong word, but it is a super-large task," Rep. Mark Walker, R-N.C., said when asked about past GOP promises to quickly deliver legislation repealing Obama's overhaul and replacing it. "We're getting there; we're getting closer."

House Speaker Paul Ryan, R-Wis., told journalists after the closed-door meeting that after Congress' upcoming weeklong recess, "We intend to introduce legislation to repeal and replace Obamacare." He provided no details.

Among the options discussed at a closed-door meeting of Republicans was repealing some or all of the $1.1 trillion in taxes over 10 years that Obama's overhaul imposed to help finance its expansion of health coverage. In its place, House Speaker Paul Ryan, R-Wis., is proposing taxing the value of high-cost health insurance provided by employers -- an idea that is certain to draw opposition from some Republicans who have long refused to vote for tax increases.

According to a document distributed to lawmakers and obtained by The Associated Press, Republicans would phase out the expansion of Medicaid to additional poor people that Obama's law enacted. Thirty-one states received extra federal money for doing that. During the phase-out period the other 19 states would also receive additional money.

Eventually, states would be given a choice of receiving either a lump sum payment of federal funds or an amount that varies based on the number of Medicaid beneficiaries they have.

"Instead of expanding a broken program, Republicans instead want to put states in charge of their Medicaid programs," the document says.

Medicaid remains among the most contentious parts of the GOP plan, with battles pitting states against each other sure to come as details of their legislation are decided.

Republicans would eliminate the tax penalties Obama's law imposes on people who don't buy insurance and the subsidies the government provides to most people buying policies on the online marketplaces the statute established. In their place, there would be refundable tax credits and health savings accounts people could use to help afford coverage — proposals Democrats have mocked as inadequate.

Refundable credits mean that even people with low or no income would receive checks from the IRS. That has drawn opposition from conservative Republicans who say that system invites fraud.

Health Secretary Tom Price, until last week a member of the House himself, addressed the lawmakers and told them President Donald Trump would give them strong backing during the effort.

According to Rep. Bill Flores, R-Texas, he also told them that the administration wants the House to introduce legislation before Trump produces his own package.

Some Republicans have been eager for the White House to advance a proposal first because they are leery of supporting something that ends up not getting Trump's backing.

Thursday's closed-door meeting came with Congress about to start a weeklong recess. That will send lawmakers home to energized voters, mostly Democrats, who have crammed town hall meetings to complain about GOP efforts to repeal Obama's law. Lawmakers are eager to have something to show constituents.

Despite the options that Ryan and other GOP leaders presented, lawmakers said they still didn't have bill text or final decisions in many areas, leaving it uncertain how quickly they will be able to vote on anything. Also still lacking are cost estimates from the nonpartisan Congressional Budget Office, which are crucial because some proposals might end up proving too costly for Republicans to support.

Echoing many of his colleagues, Rep. Pete Sessions, R-Texas, remarked as he left the meeting, "The devil's in the details."

Still, several House Republicans say they feel hopeful they might soon reach agreement.

In a significant departure from Ryan's summertime proposal, the options being discussed Thursday would not address Medicare, which helps pay for guaranteed health care for the elderly. Ryan has backed reshaping it into a voucher-like program that people could use to buy coverage, but Trump has said he doesn't want to revamp Medicare.

And because of many Republicans' opposition to abortion, the retrofitted medical system would block Planned Parenthood from receiving federal payments, which comprise nearly half its annual $1.1 billion budget.