President Obama and Vice President-elect Mike Pence both paid a visit to Capitol Hill Wednesday, in the first formal engagement over the future of the Affordable Care Act. Republicans finally have the power to repeal, but the question is whether they have the grit to replace ObamaCare.
Mr. Pence told Republicans that repeal and replace is the Trump Administration’s “first order of business,” while Mr. Obama ordered Democrats not to “rescue” the GOP by helping to pass a “TrumpCare replacement.” Going by his business background Donald Trump won’t mind putting his name on a health-care plan, or anything else, but Republicans need to appreciate the reality that they will soon own ObamaCare. Until they pass a coherent and market-oriented substitute, as a political matter ObamaCare is TrumpCare, like it or not.
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Vice President-elect Mike Pence will rally House Republicans Wednesday morning on a plan to repeal Obamacare, POLITICO has learned — a counter-punch to President Barack Obama’s visit to the Hill the same day.
Pence will meet with the full House Republican Conference to talk about the party’s plan to dismantle Obama’s signature health care law, according to a House Republican leadership aide. The meeting is House Republicans’ first of the new Congress, which kicks off Tuesday.
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Zeke Emanuel, one of Obamacare’s architects, tells NPR that there is possibility for bipartisan health care reform in replacing Obamacare. “I understand that the president-elect, Donald Trump, wants a bipartisan bill. He really does I think genuinely want a bill and a health care system that works for all Americans, that achieves universal coverage, no preexisting disease exclusions. And I think therefore there is some ray of optimism that we could actually get a compromise bill…The bill would have to construct both the repeal part but simultaneously the replacement part. And I think if you do it that way, you could begin to negotiate with Democrats.”
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In less than three weeks’ time, when Donald Trump becomes our next president, he will take an oath to preserve, protect, and defend the Constitution of the United States.
It is fitting, then, that Trump has committed to repealing and replacing one of his predecessor’s most infamous unconstitutional policies, the Affordable Care Act, or Obamacare. But he won’t be able to do it alone. Repealing Obamacare requires Congress to write legislation for the president to sign into law.
Congress can and should do this in January, before Inauguration Day. There is no excuse not to.
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My colleague Avik Roy has suggested that passing a full Obamacare replacement (as opposed to a partial replacement passed via reconciliation) might be possible even though it would require Democratic votes to obtain the 60-vote threshold in the Senate, and that a pre-condition to achieving that would require the Congressional Budget Office (CBO) score the replacement as covering at least as many people as the Obamacare does.
As if to give a warning shot across the Republican bow, the officially non-partisan CBO warned that it “would not count those people with limited health benefits as having coverage” when evaluating changes to the health care law, and that changes to the “essential health benefits” required under the ACA could result in people receiving tax credits to help pay for health insurance under a new law, but being counted as not having health insurance according to the CBO, if the coverage they have doesn’t meet the CBO’s requirements. At issue, basically, is “What is health insurance?”
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As Congress readies legislation to repeal and replace the Affordable Care Act (ACA), Congressional Budget Office (CBO) estimates will play an important and respected role as they did in the passage of the law in 2010. We now know that many of CBO’s projections of important aspects of the ACA have significantly differed from actual outcomes. In this piece, I highlight CBO’s key past errors in projecting effects of the ACA. They can largely be grouped into two categories. First, CBO projected that the exchanges would be stable by now with more than twice as many enrollees as they currently have, rather than suffering from severe adverse selection in most states as they now are. Second, CBO projected that the ACA Medicaid expansion would be much smaller and less expensive than it has turned out to be.
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AEI’s Improving Health And Health Care Plan, developed by a group of scholars affiliated with the American Enterprise Institute and released on December 9, 2015, only partially repeals Obamacare. The replacement consists of three broad components:
1. Private Health Insurance Reform. This would consist of 4 parts:
- Age-Adjusted Tax Credits. Obamacare’s income-related subsidies are replaced with less expensive advanceable and refundable tax credits that vary only by age (0-17, 18 to 34, 35 to 49, and 50 and over).
- Automatic Enrollment. Any household that does not take the tax credit they receive and purchase insurance of their choice will automatically be enrolled in a catastrophic plan equal to the value of the credit for which that household is eligible. States have the option to decline to implement default enrollment.
- Capped Tax Exclusion. The long-standing tax exclusion for employer-provided health insurance coverage is retained, but the ACA’s Cadillac tax is replaced by a functionally-equivalent cap on the amount of the exclusion ($8,000 for single and $20,000 for family coverage).
- Expanded Use of Health Savings Accounts. All households become eligible to open an HSA account regardless of enrolled health plan. Those that open an HSA can make tax preferred contributions of up to $2,000 for individuals and $4,000 for families. Beneficiaries enrolled in HDHPs would be allowed to make contributions up to the allowable amounts under current law in addition to the $2,000/$4,000 contributions allowed for all. As well, a one-time HSA credit for up to $1,000 for those that are enrolled in an HSA-compatible plan in 2017.
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The Alternative to Obamacare, originally developed by Jeffrey Anderson and released by the 2017 Project as A Winning Alternative to Obamacare, first released on February 10, 2014, starts by fully repealing Obamacare. The replacement consists of three major components:
- Obamacare’s income-related subsidies are replaced with less expensive tax credits that vary only by age (0-17, 18-34, 35-49 and 50-64).
- The long-standing tax exclusion for employer-provided health insurance coverage is retained, but the ACA’s Cadillac tax is replaced by a functionally-equivalent cap on the amount of the exclusion (set at the 75th percentile of annual employer sponsored insurance premiums); workers in firms with fewer than 50 full-time-equivalent workers would be allowed to purchase non-group coverage with tax credits.
- Annual contribution limits for health savings accounts are increased to $6,250 for individuals and $12,500 for families. As well, enrollees in health savings accounts are eligible to receive a one-time, refundable tax credit of $1,000 to be deposited directly into the account.
The Patient CARE Act, introduced on February 4, 2015 and sponsored by Senators Burr (R-NC) and Hatch (R-UT) and Rep. Fred Upton (R-MI), starts by fully repealing Obamacare “except for the changes to Medicare”. The replacement consists of three major components:
- Medicaid is reformed by imposing a capped per-beneficiary allotment adjusted for inflation (a less stringent form of block-granting Medicaid insofar as it automatically adjusts for changes in the number of Medicaid eligibles);
- Obamacare’s income-related subsidies are replaced with less expensive tax credits that vary by age, family status and income (disappearing above 300 percent of federal poverty level).
- The long-standing tax exclusion for employer-provided health insurance coverage is retained, but the ACA’s Cadillac tax is replaced by a functionally-equivalent cap on the amount of the exclusion ($12,000 for single and $30,000 for family coverage); workers in firms with fewer than 100+ workers would be allowed to purchase non-group coverage with tax credits.
Congress often waits for a new president to take office before it gets down to business. This year, Republicans will drop that custom in their dash to scrap the Affordable Care Act.
Within hours of the new Congress convening on Tuesday, the House plans to adopt a package of rules to clear the way for repealing the health care law and replacing it with as-yet-unspecified measures meant to help people obtain insurance coverage.
Then, in the week of Jan. 9, according to a likely timetable sketched out by Representative Greg Walden, Republican of Oregon, the House will vote on a budget blueprint, which is expected to call for the repeal of the Affordable Care Act.
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