Republican leaders in the House of Representatives on Friday pushed back against conservative criticism of their Obamacare replacement effort, saying the embattled reform bill is just step one toward undoing the landmark health-care law.
"This is going to take time to get all of those other pieces in place, but we are committed to reforming this," said Rep. Kevin McCarthy, R-Calif., House majority leader.
"There's not everything we'd like to have in the first phase."
But, "we're not going to sit back, because Obamacare is failing," McCarthy said at a news conference in Washington. "Now is the time to act."
McCarthy and other leaders said that two more phases of the repeal effort will achieve the common goals Republicans share in undoing the Affordable Care Act.
Those next two phases are further legislation introduced in Congress — which McCarthy said could happen soon — and administrative changes by Health and Human Services Secretary Tom Price.
The first phase is the GOP's American Health Care Act, which was passed by two House committees Thursday, and is now headed to other committees for review.
"We're not stopping here. This is just the beginning of our work," said Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas.
He and other GOP leaders met with President Donald Trump Friday to discuss the bill.
Trump has said he supports the bill. But he reportedly also has been meeting with critics of the bill, and indicating there may be room for negotiation to assuage some of their concerns.
The promises of more reform work by GOP leaders comes as conservative members of Congress, as well as right-leaning health-care analysts and think tanks continue criticizing the pending AHCA bill, which would undo key parts of Obamacare.
Some of those critics don't like the bill because it is not a wholesale repeal of Obamacare. Others object to the fact that it doesn't immediately roll back the expansion of Medicaid benefits, and because it would issue tax credits to people to help reduce the cost of their individual health plans.
There is also concern that the bill — dubbed "Obamacare Lite," and "Obamacare 2.0" by some critics — will lead to increases in the federal deficit, the number of Americans who are uninsured and insurance premiums.
McCarthy said that critics who seek wholesale repeal of Obamacare, without having a replacement plan to put in place at the same time, are being unrealistic.
He said a simple repeal would lead insurance premiums to "double ... and you would collapse the market."
And then, McCarthy said, Republicans would "wait here to get 60 votes" to pass replacement legislation in the Senate.
McCarthy's comments reflect both the predictions of health-care analysts, and the complex method the GOP is using to repeal and replace Obamacare.
Analysts have said that a simple repeal of Obamacare could lead to the loss of health-care insurance coverage for up to 30 million people, as well as sharply higher premium prices for the remaining handful of people who would remain in the individual insurance marketplace.
To avoid that doomsday scenario, the AHCA bill both delays a freeze on the expansion of Medicaid benefits, and would subsidize purchases of individual plans to a certain extent.
To pass the AHCA, Republicans are relying on a process known as budget reconciliation, which can be used only for budget-specific legislation.
Reconciliation bills require only a simple majority to pass — and Republicans hold a majority in both chambers of Congress.
The additional Obamacare replacement legislation the GOP intends to pass could not be done through reconciliation. That means Republicans will have to get 60 votes in favor of such bills in the Senate, where they hold 52 seats.
"We have to get 60 votes to move forward," McCarthy said. "That will be a very difficult thing to do."
It will be hard because Democrats are staunchly opposed to repealing Obamacare.
GOP leaders are hoping that by partially repealing and replacing the law through a reconciliation bill first, they would shift the political calculus in the Senate, and then be able to peel off enough Democrats to support additional legislation to reform the health-care system.