As recently as last week, House Speaker Paul Ryan was committed only to passing legislation taking the place of the Affordable Care Act sometime in 2017, with the understanding that it would not actually take effect until after an orderly transition out of the current system.
By Tuesday morning, however, that timetable had shifted considerably. “It is our goal to bring this all together concurrently,” Ryan told reporters after a party meeting. He indicated that Republicans would try to pass as much of the replacement as possible through the budget process known as reconciliation, which allows the Senate to clear legislation dealing with taxes and spending through a simple majority vote rather than a filibuster-proof 60 votes. Yet experts on Senate procedure have said that while Republicans can scrap much of Obamacare using that process, most of the replacement would have to go through regular order, requiring 60 votes—and thus, some Democratic support.
The stated timeline for a replacement has moved up following complaints from Republican senators about the “delay” part of the leadership’s original strategy. Senator Rand Paul of Kentucky, a former Trump rival for the GOP presidential nomination, has emerged as a leader of that pushback. He voted against the first procedural step Republicans took to set up repeal in the Senate last week, and in the days since he has sought to rally support—and even enlist Trump—in a bid to repeal and replace the law simultaneously. Judging by Trump’s comments to the Times, the president-elect seems to be coming down in the middle of that debate—not a simultaneous repeal-and-replace vote, but not a long delay either.