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Today in Obamacare: Paul Ryan yet again promises the GOP plan is right around the corner

Could he be right this time?

Cheriss May/NurPhoto via Getty

For weeks, the word in Washington has been that Republicans are hopelessly divided on Obamacare repeal, with no solutions in sight.

But on Thursday morning, Speaker Paul Ryan announced that he and House Republicans would at long last release their Obamacare repeal-and-replace bill shortly after returning from next week’s recess. (Congress’s schedule has them returning to Washington on Monday, February 27, so mark your calendar for then.)

The specifics of the legislation remain elusive. Paige Cunningham of the Washington Examiner posted a 19-page document House Republicans were given at a briefing this morning, and overall, it seemed to be a restatement of Ryan’s previously released “A Better Way” plan. But it lacked many details that would help settle some of those gnawing internal GOP disagreements.

Still, if in fact the House GOP is far enough along to have a bill being scored by the Congressional Budget Office — as Ryan seemed to suggest at his presser today — we truly might see at least a starting point for the legislative process soon.

But it will surely be very far from an endpoint. As I wrote in January, the introduction of a bill just kicks off a complex and convoluted legislative process involving frantic lobbying by stakeholders, proposals for amendments, arm twisting, and deal cutting.

Indeed, a report from Bloomberg’s Arit John, Anna Edney, and Billy House gives a clue as to one topic that could cause serious controversy. As an effort to pay for the replacement plan, the House GOP is seriously considering capping the currently unlimited exclusion of employer-sponsored health insurance from federal taxes.

Wonks on both the left and right have long seen that tax break as a wasteful subsidy that distorts health spending decisions. But as all would-be health reformers eventually discover, the majority of Americans who have insurance currently get it through employers — and they’re distinctly uninterested in changes to their tax treatment.

In 2008, GOP nominee John McCain discovered this when Barack Obama ran ads criticizing him for proposing to raise taxes on health insurance. As president, Obama also discovered it, when Obamacare’s “Cadillac tax” ended up incredibly unpopular and indefinitely postponed.

Furthermore, since Obamacare repeal means eliminating its tax hikes that targeted rich people, the optics of doing this while capping a tax break enjoyed by a much broader section of Americans could be devastating. “It sounds like we are going to be raising taxes on the middle class,” Sen. Bill Cassidy (R-LA) said in leaked audio from the GOP’s congressional retreat. So it’s unclear whether the congressional GOP is fully aware of the firestorm it could be walking into.

And there’s this other problem...

I touched on some of these issues Republicans will have paying for Obamacare in a post this morning, in which I explored the five biggest disagreements the GOP currently has about what to do on Obamacare.

But I did leave out one big and important issue that doesn’t necessarily have any relationship to the health law but that I’ve been hearing could throw a wrench into the process nonetheless.

That’s the topic of Planned Parenthood funding. Currently, there’s an expectation on the Hill that conservatives in the House will demand that any Obamacare repeal bill also cut off all federal funds to Planned Parenthood.

But moderates in both the House and Senate are hesitant to take on such a controversial fight. In the leaked retreat audio reported by the Washington Post’s Mike DeBonis last month, Rep. John Faso (R-NY) argued, “Health insurance is going to be tough enough for us to deal with without having millions of people on social media come to Planned Parenthood’s defense and sending hundreds of thousands of new donors to the Democratic Senate and Democratic congressional campaign committees. So I would just urge us to rethink this.”

In the Senate, the GOP can only afford to lose two votes. Sen. Susan Collins (R-ME) appears to be a hard no on defunding Planned Parenthood, while Sen. Lisa Murkowski (R-AK) has also expressed reluctance to defund the group. If Republicans lose both of them, they have to hold on to all their other members to pass a repeal bill through the reconciliation process. (Update: A spokesperson for Collins has emailed me and made the case that, since no Obamacare legislation has been released yet, it’s premature to call the senator a “hard no.”)

Recall that back in 2009, the original Obamacare legislation was nearly derailed late by a group of pro-life Democrats led by then-Rep. Bart Stupak over the topic of whether federal dollars could be used to subsidize purchases of plans that covered abortion, until a compromise was eventually worked out. So keep your eye on this topic as the Obamacare debate moves forward in Congress.

Today’s health policy and politics links

  • Sarah Kliff interviewed top executives from Oscar, the startup health insurer co-founded by Jared Kushner’s brother, and found the company is still bullish on Obamacare’s individual marketplaces.
  • Meanwhile, Dylan Matthews checked in on Republicans’ overall congressional strategy, which is at risk of being derailed if they can’t agree on what to do about Obamacare soon.
  • Jenny Gold of Kaiser Health News writes about a new study on how doctor assignments of emergency room patients could affect long-term opiate use. “Patients who saw a high-intensity prescriber were about 30 percent more likely to end up with a long-term opioid prescription of at least six months within the year following their hospital visit,” Gold writes. “They were also more likely to return to the hospital in the next 12 months with an opioid-related fall or fracture, a risk factor for seniors who take the powerful painkillers.”