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The vast majority of Republicans in Congress havent budged from their longstanding vow to completely repeal the Affordable Care Act. But as the party struggles to write a replacement, a few GOP lawmakers are declaring their support for keeping the law on the books in some form indefinitely.

A group of senators on Monday unveiled legislation that would give states the option of preserving Obamacare, securing federal support for a more conservative health-insurance system, or opting out of any assistance from Washington. Offered as a middle ground in the partisan health-care fight, the proposal breaks with years of Republican orthodoxy on the 2010 law, which party leaders have pledged to rip out root and branch.

Republicans think that if you like your insurance, you can keep it. And we mean it, said Senator Bill Cassidy, a Louisiana Republican and the lead author of legislation he has titled the Patient Freedom Act of 2017. We give states the choice, he said at a Capitol press conference. So California and New York, you have Obamacare, you can keep it. I disagree with it, but Republicans think power is best held at the state level, not by Washington, D.C., so its not for us to dictate.

A Possible Republican Truce on Obamacare

Cassidy introduced a similar proposal last year along with Representative Pete Sessions, a House Republican from Texas. But the bill was ignored by Cassidys Senate colleagues and went nowhere. This time around, hes secured early support from three fellow Republicans in the Senate: Susan Collins of Maine, Johnny Isakson of Georgia, and Shelley Moore Capito of West Virginia. Cassidy, Collins, and Isakson all sit on the Senate committee that will be charged with drafting a replacement plan for the Affordable Care Act.

The Cassidy bill would repeal both the employer and individual insurance mandates in Obamacare while retaining the more popular consumer protections allowing people to stay on their parents plan through age 26 and banning discrimination based on pre-existing conditions. It would still require insurers to cover mental-health and substance-abuse disorders. States could choose to continue to run ACA exchanges and expanded Medicaid, although there would be a 5 percent cut in federal support for subsidies and tax credits. Or they could receive the same level of federal funding to pursue a more conservative program based on expanded health savings accounts and high-deductible plans, which are the hallmarks of many Republican proposals to replace Obamacare.

Whether the Cassidy proposal could function as intended is unclear. The ACA is a complex and highly interconnected law, and its proponents have argued that keeping popular provisions while removing the mandates designed to make them affordable would be nearly impossible. States could also auto-enroll residents in basic health plans, which Cassidy said was designed as an alternative to the ACAs requirement that individuals buy insurance or pay a tax penalty. Maintaining a large enough pool of healthy people enrolled in coverage, he acknowledged, was essential to continuing the ban on insurance companies being allowed to deny plans to consumers with conditions that would be more expensive to cover.

Another challenge for Cassidy and his colleagues is that their proposal represents a compromise at a moment when neither side of the healthcare fight is ready for one. Democrats attacked the plan for its funding cuts and for the likelihood that many Republican-led states would choose to abandon the federal law and kick millions of their residents off the exchanges and Medicaid. Ultimately, this proposal is an empty facade that would create chaosnot carefor millions of Americans, Senate Minority Leader Charles Schumer said.

Conservatives were equally dismissive of the proposal, which would keep the tax increases included in the original law. It doesnt repeal Obamacare, and thats been a Republican pledge since 2010, said Jason Pye, director of public policy and legislative affairs from FreedomWorks, the conservative advocacy group.

Pye said congressional Republicans must, at the very least, pass the same bill that former President Obama vetoed last year, the Restoring Americans Healthcare Freedom Reconciliation Act, which repealed all of the tax-and-spending provisions in the law. Anything other than that, and there will be hell to pay from grassroots activists, he told me. We cant nibble around the edges here. We can't sit here and try to be cute with this effort. We either need to be all in, or Republicans are going own Obamacare. Dan Holler, a spokesman for the conservative Heritage Action, offered a similar criticism. Giving states the ability to keep Obamacare will not empower patients; too many will remain trapped in a failing, centrally controlled system, he said. Congressional Republicans promised to repeal Obamacare for all Americans, not just some. They promised to provide more freedom and choice for all patients, not just some.

That Cassidys bill is getting a second life exemplifies the GOPs dilemma on Obamacare: Republican leaders want to repeal the law as fast as possible, but they have encountered resistance from President Trump and a growing number of rank-and-file lawmakers who are demanding that a replacement be ready immediately. Republican governors in states that embraced the ACA and expanded Medicaid have also warned Congress against taking action that could destabilize the insurance market and threaten coverage. We recognize that our bill is not perfect. It is still a work in progress, Collins said. But if we do not start putting specific legislation on the table that can be debated, refined, amended, and enacted, then we will fail the American people.

Trump on Friday signed an executive order aimed at laying the groundwork for repeal by directing federal agencies to ease the burden of the law on consumers, insurers, and businesses. But in a sign of the division among Republicans on the issue, Collins criticized the order as very confusing. We really dont know yet what the impact will be, she said.

To supporters of Obamacare, the GOP bill represents less a serious policy proposal than an attempt by nervous legislators to grasp onto anything they can describe as a replacement.

It shows that a handful of Republican senators are extremely uncomfortable with repeal and delay, and theyre desperately looking for a way out, said Topher Spiro, vice president for health policy at the liberal Center for American Progress.

The Cassidy bill could begin to look more appealing to some Democrats if Republicans succeed in repealing most of the Affordable Care Act later this year with a simple majority vote in the House and Senate. It would keep the law alive and offer the chance that states would re-embrace it once theyve experienced the alternative. But as they watch Republicans struggle to keep the hardline promise theyve made to their base, Democrats are in no hurryyetto negotiate.

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The Republican Health Plan That Doesn't Repeal Obamacare - The Atlantic

Republicans on Capitol Hill are coming to the Trump administrations defense after the new president declared over the weekend he has a running war with the media.

President Trump and White House press secretary Sean Spicer inaccurately claimed over the weekend that Friday's inauguration was the most-attended in history in defiance of all available data, including aerial photographs, TV ratings and statistics from Washington's Metro system.

But that didn't stop House Science Committee Chairman Lamar Smith (R-Texas) from taking the House floor Monday night to claim the media would cover Trump differently if he werent a Republican.

"No, the national liberal media wont print that or air it or post it. Better to get your news directly from the president. In fact, it might be the only way to get the unvarnished truth, he concluded.

Smith delivers House floor speeches at least once a week criticizing the mainstream media. Earlier this month, he denounced a New York Times column describing the impact of droughts in Africa believed to be exacerbated by climate change as fake news.

His comments on the House floor reflected a similar sentiment expressed earlier in the day by Spicer, who at the White House press briefing said the "negative" media coverage is "demoralizing."

"Its not just about a crowd size. Theres this constant theme to undercut the enormous support he has," Spicer said of Trump. "And its unbelievably frustrating when youre continually told its not big enough, its not good enough. You cant win."

Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, argued the Trump team's claims were simply commentary on media coverage.

"I think they are trying to make a case when the press is saying something, dont necessarily take it at face value. Just like hes done to other elected officials," Walker said during a briefing with reporters in his Capitol Hill office on Monday.

When asked if it could be problematic for GOP policy priorities if Trump can't stay on message, Walker acknowledged that "it may be at some point."

But Walker suggested that Trump needed some time to adjust to the office for which he campaigned over the course of more than a year.

"Youre talking about someone who transitioned out of a different world where he was basically in charge of everything," Walker said. "There is a learning curve. Now, when you talk about discipline of message, thats part of what I would say is a political maturation.

"This is a new place in understanding the parameters that our founding fathers laid out many years ago."

Not all Republicans are siding with Trump on the issue.

Earlier Monday, Rep. Adam Kinzinger (R-Ill.) acknowledged the Trump administration had gotten off to a rocky start. He sympathized with the Trump teams sense of media bias, but warned they shouldnt try to promote falsehoods.

"There's a big danger, because there's one thing to push back against perceived media bias as Republicans, we like to see that. It's another thing to come out and say that a fact is only a fact if it fits into your world view," Kinzinger said.

"The campaign way of doing things could get very old if, in fact, this becomes what the new president's team is. I would definitely discourage them from using the term 'alternative facts' again, he said, referring to a term coined by Trump adviser Kellyanne Conway during an interview with NBCs Chuck Todd on Sunday.

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Republicans defend Trump on media coverage - The Hill (blog)

Wall Street Journal

Some Republicans Wary of Repealing ACA Without Replacement Plan Wall Street Journal WASHINGTONSenate Republicans' narrow margin of power creates plenty of questions for leaders tasked with steering through the party's repeal of the 2010 Affordable Care Act. High on the list: What does Susan Collins want? Sen. Collins, a Maine ... The Republicans Own Obamacare Now. How Many People Will They Let Suffer?New York Magazine Why are Republicans so happy to take away healthcare?Los Angeles Times Republican Plan To Replace Obamacare Would Turn Medicaid Over To StatesNPR New York Times -Washington Post -Bloomberg all 1,341 news articles »

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Some Republicans Wary of Repealing ACA Without Replacement Plan - Wall Street Journal

The Hill (blog)

Republicans race to find ACA repeal compromise Sacramento Bee President Donald Trump wants Congress to move quickly this week to dismantle the Affordable Care Act, but congressional Republicans are far from consensus on a repeal-and-replace effort that won't leave millions of their constituents without insurance. This week: Congressional Republicans prepare to huddle with TrumpThe Hill (blog) Cautious welcome from congressional Republicans to Trump eraLas Vegas Sun Republicans are in charge, so let's work on the national debtChicago Tribune KPVI News 6 -Washington Examiner (blog) all 57 news articles »

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Republicans race to find ACA repeal compromise - Sacramento Bee

Ohio Governor John Kasich at a White House event in Nov. 2016. in Washington, DC. President Obama hosted the Cavaliers to honor their 2016 NBA championship. Cheriss May/NurPhoto via Getty Images hide caption

Ohio Governor John Kasich at a White House event in Nov. 2016. in Washington, DC. President Obama hosted the Cavaliers to honor their 2016 NBA championship.

As Congressional Republicans begin work on repealing the Affordable Care Act, many of the nation's governors want to make sure that their state budgets don't take a hit during the dismantling process.

They're most concerned about Medicaid, the health insurance program for the poor that's run jointly by the states and federal government. As a result of a Supreme Court decision, states were allowed to decide whether they would expand Medicaid under the ACA. 14 million people have gained health insurance coverage through Medicaid since eligibility for the program was expanded.

While 19 states declined the expansion, primarily due to the opposition of Republican governors and lawmakers, several Republican governors did choose to expand the program. Now they're lobbying to keep their citizens covered and billions of dollars of federal Medicaid money flowing.

Among them is Ohio Gov. John Kasich who, along with several other Republican governors, met with GOP members of the Senate Finance Committee last week for a closed-door discussion about the healthcare law.

Kasich has been anything but quiet on the subject.

In a letter to Congressional leaders, Kasich recommended that Medicaid expansion not be repealed, while indicating he's open to some changes, such as in income eligibility. Kasich urged Congress in an op-ed on Time.com to pass an Obamacare replacement at the same time as a repeal.

"For the millions of Americans who have gained health coverage since 2010, it's safe to assume that their idea of fixing Obamacare does not involve ripping away their own health care coverage without a responsible alternative in place," wrote Kasich.

'If I had to pay for my medical costs, I wouldn't be taking no medicine'

Evelyn Johnson is among those who would be affected were the ACA repeal to also roll back the Medicaid. She sat in the back of the cafeteria at a social services drop-in center in Cleveland last week as a pair of healthcare navigators made calls to help people sign up for Medicaid.

"So far I've got a pair of glasses. They're going to do my teeth," she said of the benefits she's received since getting health insurance.

Johnson, who lives with a friend, does not have children and works as a babysitter, would not have been eligible for state-backed insurance before the Medicaid expansion, when it was limited largely to low-income children, parents and people with disabilities.

Now, anyone whose income is at or below 138 percent of the federal poverty line, about $16,000 a year for a single person, is eligible.

Without insurance, Johnson said she would not able to afford the prescription drugs she needs.

"If I had to pay for my medical costs, I wouldn't be taking no medicine," she said. "There's no way. I take too many pills."

Around 700,000 Ohioans have signed up for expanded Medicaid since January 2014. Since the Affordable Care Act came into effect, Ohio's uninsured rate has fallen to 6.5 percent from 15 percent in 2012.

Unpopular position with Republicans

Kasich's decision to expand Medicaid was unpopular with Republicans. He fought his own party and sidestepped the state legislature to get the expansion done.

At an event with business leaders earlier this month, Kasich argued it's been a good deal for the state.

"If they don't get coverage, they end up in the emergency room, they end up sicker, more expensive. I mean, we pay one way or the other," Kasich said. "And so this has been a good thing for Ohio."

Also defending their decisions to expand Medicaid are such Republican governors as Rick Snyder of Michigan, Brian Sandoval of Nevada and Gary Herbert of Utah.

"So if all of a sudden, that goes away, what do we tell these 700,000 people? We're closed? Can't do that," Kasich said at the business event.

Medicaid covers about one in four people here in Ohio. If the expansion is rolled back, it will mean fewer payments to doctors and hospitals.

"You pull on one thread, you topple the whole tower," said John Corlett, who ran the Medicaid program in Ohio under the previous Democratic governor.

"There's nothing to say that the program can't be improved, that it can't be made better," Corlett, who now runs a think tank in Cleveland called the Center for Community Solutions said. "But just to say we're going to get rid of all of it, and then we'll figure out how to make it better, I think would be really disruptive. It'd be disruptive to healthcare providers, to patients, to insurance companies."

Changes coming?

Even if the Medicaid expansion remains, the new Trump administration may make major changes to it in the future.

Last year, Ohio asked the federal government to require beneficiaries to pay into health savings accounts, a request the federal government denied.

"I think that with the constellation in Washington the way that it is, that there's going to be an awful lot of opportunities," said Greg Lawson, a senior policy analyst with the Buckeye Institute, a conservative think tank in Ohio that opposed expansion.

Lawson would like to see limits on federal spending per state, and hopes Ohio will be able to add a work requirement for some beneficiaries.

"I don't think you're going to see the light switch probably just get turned, and one day it's all going to just disappear," he said. "I think what you're more likely to see is major structural changes to the program that over time that will have budgetary impacts."

But it's not clear yet what shape those changes will takeor whether the governor who expanded Medicaid here will support them.

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Meet The Republican Governors Who Don't Want To Repeal All Of Obamacare - NPR