President Obama will huddle with Congressional Democrats Wednesday morning to help plot the political defense of his signature health care law while Vice President-elect Mike Pence meets with GOP members to rally his party around efforts to dispose of it.
But the battle really began in earnest on Tuesday when Republicans made the first move to undo the Affordable Care Act through a Senate budget resolution, beginning their long, complicated journey to repealing and replacing the Democrats' signature achievement.
The Senate Budget Committee's resolution, which starts a two-step process known as reconciliation, directs two committees in the House of Representatives and two committees in the Senate to do the hard work of writing the language that repeals the bill.
But even just repealing the massive bill is proving onerous as Republicans debate the merits of doing so without a replacement ready.
House Republicans have a lot of practice repealing the law, but have never had to deal with what might come next. They passed a repeal of Obamacare more than 60 times over the last six years, including one proposal that is said to be the framework for the current effort that reached Obama's desk in 2015. He vetoed it.
Now, however, with a Republican president about to assume the Oval Office, any legislation they pass will have real-world consequences. They must consider the 20 million people who have gained insurance through the ACA, business interests of the health care industry and the impact any changes will have on the economy. In addition, Republican leaders have to balance the economic impact with the demands of their members who span the conservative ideological spectrum.
Fractures are already forming around the timeline for replacement, the tax components that have raised billions of dollars and how far-reaching the scope of the repeal should be — all elements that must be addressed in the repeal legislation.
Members of the House Freedom Caucus, including its leader, Rep. Mark Meadows of North Carolina, are insistent on the timeline, threatening to vote against any replacement if it is not guaranteed before the midterm elections in 2018.
"It would have to be an unbelievable, compelling case to suggest we need more than two years to repeal and replace the Affordable Care Act," Meadows said Tuesday.