President Trump, the House and the Senate have all taken the first steps toward repealing the Affordable Care Act. Yet many critics (and even supporters) of the move share a common concern: With the ACA gone, what comes next?
We hope any replacement plan engages the states as true partners and allows for greater local accountability. Fortunately, there is already a mechanism to let states take the lead — a shift that would generate bipartisan consensus the ACA never achieved.
The Department of Health and Human Services has discretion under the ACA to offer states waivers from many of the law’s most expensive and onerous regulations. The Trump administration can use the waivers to immediately signal its commitment to promoting market competition and empowering patients and consumers. Along with new reforms to promote transparency on pricing and quality, the administration and Congress can facilitate a health care revolution from the ground up.
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President Donald Trump’s administration made explicit this weekend its commitment to an old GOP strategy for managing Medicaid, the federal-state insurance plan that covers low-income people — turning control of the program to states and capping what the federal government spends on it each year.
It’s called “block granting.” Right now, Medicaid, which was expanded under the 2010 health reform to insure more people, covers almost 75 million adults and children. Because it is an entitlement, everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs. Conservatives have long argued the program would be more efficient if states got a lump sum from the federal government and then managed the program as they saw fit. But others say that would mean less funding for the program —eventually translating into greater challenges in getting care for low-income people.
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It is not a question of whether or not Republicans and Democrats will come to a compromise over replacing Obamacare.
Since it will take 60 Senate votes, and the Republicans only have 52 seats, there is no way we can get to a solution to the Obamacare conundrum without a bipartisan compromise.
So, what might that look like?
We can’t underestimate the fundamental ideological differences between Democrats and Republicans on the entitlements–of which Obamacare is just one.
First, think of an old-fashioned pension plan as a defined benefit plan. The employer promised a set benefit based upon years of service and wages for the rest of the retiree’s life. If the stock market crashed, the employer guarantee would continue. In a defined benefit plan, the sponsor takes the risk of being able to pay the benefits.
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Despite heated congressional hearings on whether Rep. Tom Price should head the U.S. Department of Health and Human Services, President Donald Trump’s promise to “repeal and replace” the Affordable Care Act is already in motion.
On Inauguration Day, Trump signed an executive order urging federal officials to “take all actions consistent with law to minimize the unwarranted economic and regulatory burdens” of the federal health law.” Meanwhile, several Republican plans for a replacement to the law are in the works, including proposals to block grant Medicaid and another that would allow states that embraced the law to maintain it.
The American public appears divided on the law, which has resulted in coverage of more than 20 million people. A Kaiser Family Foundation poll conducted in December found that Americans are evenly divided on the fate of the law — 49 percent of respondents said Congress should vote to repeal it, while 47 percent said they should not. Just one in five agreed with the Republican strategy of repealing the law before creating a replacement. (KHN is an editorially independent service of the foundation.)
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