First steps to a repeal are under way in Congress

The quest to repeal and replace the Affordable Care Act began even before Donald Trump was sworn in as president.

More than two weeks before Trump's inauguration, the Senate made its first move, approving a procedural motion on Jan. 4 to start debate on a budget resolution.

Passing a budget resolution is a key step in repealing President Barack Obama's signature health care law. It allows the Republican majority in Congress to repeal sweeping portions of the law with just 51 votes in the Senate. This process, known as reconciliation, saves the majority from having to round up the 60 votes required to break a filibuster -- a much tougher challenge.

On Jan. 12, the Senate passed the budget resolution itself, 51-48. Every Democrat voted against it (except for Sen. Dianne Feinstein, D-Calif., who was recuperating from surgery). The only Republican to cross party lines to vote with Democrats was Sen. Rand Paul, R-Ky., who had expressed concerns about repealing the law without a replacement ready to go.

The budget resolution includes instructions that provide the tools necessary to repeal the law.

Among other things, it instructs the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee to submit legislation to the Senate Budget Committee by Jan. 27.

The following day, Jan. 13, the House took up the budget resolution, as is required before the reconciliation process can begin. It passed, 227-198, with nine Republicans siding with Democrats and no Democrats siding with Republicans. The resolution directs the House Energy and Commerce Committee and the House Ways and Means Committee to submit legislation to the House Budget Committee by Jan. 27, 2017.

With the budget resolution out of the way, the next step is to draw up an actual reconciliation bill. The reconciliation process is hardly unknown in the context of the health care law: The Democrats used it to pass the ACA in 2010 after they lost their 60-vote Senate margin in a special election.

Still, using reconciliation to repeal the Affordable Care Act has its challenges. While the ACA has a multitude of provisions, the reconciliation process can only address matters related to federal spending and taxes. (The final judgment on what qualifies for inclusion lies with the Senate parliamentarian.)

That means that payment and tax provisions can be rewritten through a reconciliation bill, but other elements of the law not involving the federal budget would have to wait for a separate bill -- one that would almost certainly need to be passed with 60-vote majority.

So it will be much easier for Congress to pick apart the law ("repeal") than enact new legislation ("replace").

Some Republican senators -- including Susan Collins of Maine, Tom Cotton of Arkansas and Paul of Kentucky -- have urged their colleagues to repeal the law only after a credible replacement alternative is ready. Similar sentiment exists in some portions of the House Republican Conference, though the GOP's wider margin in the House make that chamber less of a worry for repeal-and-replace backers than the Senate.

Notably, Trump told the New York Times that he, too, wants a replacement in short order.

"Long to me would be weeks," Trump said. "It won't be repeal and then two years later go in with another plan." Rather, he said, "the 'replace' will be very quickly or simultaneously, very shortly thereafter."

But no such consensus Republican replacement plan has emerged to date, much less a plan that might attract some Democratic support. And getting a credible replacement plan in place by Jan. 27, or even a month or two after that, is considered a heavy lift, given the complexity of the policy task and the fault lines between lawmakers. Some are speculating that the Jan. 27 deadline will be moved.

So House and Senate Republicans have laid the groundwork for repealing at least some of the key tax-and-spending elements of the ACA, but a full "repeal and replace" is much further away and could remain tricky for both procedural and substantive reasons.

Still, this is enough to rate this promise In the Works.