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House Speaker Paul Ryan says 'I have no doubt we'll pass' Obamacare replacement

Rep. Paul Ryan
J. Scott Applewhite | AP

Read his lips: This Obamacare replacement will become law — despite strong pushback from conservative lawmakers.

House Speaker Paul Ryan on Wednesday said, "I have no doubt that we'll pass" the Republican leadership's bill to repeal and replace major parts of the Affordable Care Act, "because we're going to keep our promise."

Ryan, whose bill faces major headwinds from conservatives in the Republican congressional caucus, said the GOP has made a "covenant" with the American people over the past seven years to get rid of the landmark health-care reform law implemented by President Barack Obama.

"This is a monumental, exciting conservative reform that fixes" a slew of problems with Obamacare, said Ryan, R-Wis., shortly before two key House committees began work on the bill.

"This is a good day."

Ryan also said that he expected that the nonpartisan Congressional Budget Office would release a "score" of the bill at "the beginning of next week," before the legislation is brought to a vote before the full House of Representatives.

That score would estimate both the costs and revenues for the federal government from the bill, as well as the number of people likely to end up having health coverage after it is enacted.

"This is what we've been dreaming about doing, and we know it's going to make a positive difference in people's lives," Ryan said of the GOP replacement plan.

Republicans have in fact dreamed, and promised, for years to repeal Obamacare. And with the election of President Donald Trump, they finally have a realistic political chance of getting that done given the GOP control of both the House of Representatives and the Senate.

But the bill Republican leaders unveiled Monday night quickly drew opposition from a number of more conservative members of the House and Senate, along with conservative health-care analysts and think tanks. Providers of medical care, including the American Medical Association, the American Hospital Association and the American Academy of Family Physicians, have also voiced opposition to the proposed law.

Some conservatives object to the bill because it would not be a wholesale repeal of Obamacare, and because it includes refundable tax credits that people could use to buy individual health plans, and maintains the expansion of Medicaid benefits to a certain degree.

Conservative health analysts object to the bill because they believe it would lead to a winnowing of health coverage for the poor, while benefiting wealthier people.

In the Senate, four senators have said they will oppose a rollback of Medicaid coverage, as the bill seems to do by shifting federal funding of that program to a system of block grants to states. And several other senators object to the bill's defunding of Planned Parenthood.

The opposition could be strong enough to derail the bill in either the House or Senate.

Ryan said immediate action is needed on Obamacare because "this law is rapidly collapsing."

"Let's not forget that," he said.

Republicans point to double-digit percentage increases in the price of individual insurance plans, as well as the fact that one-third of U.S. counties have just one insurer selling such plans, as evidence of the law's collapse. They also say that Obamacare customers cannot afford to use their coverage because out-of-pocket charges for health services are too high.

Democrats dispute all of those claims, and warn that the Republican plan will actually lead to higher plan deductibles, less affordable monthly premiums and even more insurers leaving the marketplace.