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Today in Obamacare: Congress thought it would write Obamacare’s replacement. Trump has other ideas.

President-Elect Trump And Vice President-Elect Pence Meet With House Speaker Paul Ryan On Capitol Hill Photo by Zach Gibson/Getty Images

Welcome to Today in Obamacare, Vox’s regular update on the battle over the Affordable Care Act, the changes a new president and new Congress might make, and what it means for the American people. Have a story you think should be here? Send an email to

Obamacare, meet Trumpcare Of the many major questions about just how the Obamacare repeal fight will play out, one of the biggest has been what role President-elect Donald Trump will play. When asked about the topic at his press conference Wednesday morning, Trump helped clarify that somewhat — though he left a whole lot unsettled.

First, rather than leaving it to Congress to hash out what the replacement should look like, Trump made clear he’s going to release his own plan after all — after his secretary of health and human services pick, Rep. Tom Price, is confirmed by the Senate.

Second, Trump is very much picking his own timeline too. He confirmed that he has no interest in the “repeal and delay” plan Republican leaders have pushed, a plan that would put off the “replace” step for some time. “It will be repeal and replace. It will be essentially simultaneously,” Trump said. “Very complicated stuff.”

Though this plan will inevitably end up being known as Trumpcare, the president-elect didn’t say much about what it would contain. But his mention of Price seems to indicate that the HHS secretary will have a leading role in developing it. For a potential preview, read up on the Empowering Patients First Act, the plan Price submitted to Congress back in 2015.

Trump’s formal role in this process will simply be to sign (or veto) whatever gets through Congress. Technically, the House and Senate have no obligation to go along with the plan he releases. But the president has a big megaphone, and, so far at least, he’s still quite popular among Republican voters — so when he releases his plan, Congress will take note. Afterward, though, they’ll have to hash out the details themselves.

Meanwhile, on Capitol Hill Congress will continue moving forward on the Obamacare repeal process, likely voting on the budget reconciliation resolution late tonight or early Thursday. To be clear: This vote does NOT repeal the Affordable Care Act. Instead, it allows committees to start doing the work to figure out how to repeal Obamacare and what parts to kill. Some are calling the budget reconciliation resolution the “Obamacare repeal resolution” — which is confusing! Passing this resolution is one step in a three-part process that is far from over.

If you prefer your explainers in cartoon form, check out this great explainer on how Obamacare repeal via reconciliation will work from my colleague Alvin Chang. We also have a words-only explainer on this and a Q&A with congressional procedure expert Sarah Binder.

File under looming disasters Here’s an important point from the New York Times’s Jonathan Weisman about one obstacle Republicans will confront in the not-so-distant future:

Right now Republicans can pass repeal through the budget reconciliation process with just 51 votes. But a replacement plan, which would have to deal with non-budgetary matters, would need 60 votes in the Senate to pass. Given that Republicans only have 52 votes in the chamber, that would mean a good number of Democrats signing on.

Republicans do have one option if they want to pass a replacement bill without Democrats: They could eliminate the filibuster altogether. There is not much discussion of this at all right now on the Hill, but if Republicans find themselves stuck, it feels like something that could make it onto the agenda.

Kliff’s Notes: today’s three top health care reads

  • “Screwing Congress”: “That ambiguity gives Trump an opening. The Obama administration interpreted the ACA to favor members and staffers. Trump could re-interpret it to screw them.”
  • “Democrats should write their own ‘terrific’ replacement plan”: “By stitching together bits and pieces of Trump’s rhetoric with various improvement proposals offered over the years by the Obama administration and the Clinton campaign, Democrats can and should devise an affordable replacement scheme that moves the country closer to the single-payer system they mostly agree would be theoretically superior.”
  • “Insurance exec casts doubts on Obamacare repeal”: “Michael Neidorff, chief executive of Centene Corp., noted that more GOP senators are expressing deep concerns with repealing the Affordable Care Act without immediately replacing it. ‘I don't think the Republicans even have enough senators at this point,’ Neidorff said at the JPMorgan Healthcare Investor Conference.”

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