The demise of the American Health Care Act (AHCA) was ultimately precipitated by factional opposition to different provisions of the bill. Moderate and conservative members of the Republican conference did not agree on much, except they shared an animus towards the ill-fated legislation.
The future of health-care reform is now highly uncertain. Forging a legislative consensus will continue to be a challenge due to the inherent trade-offs between broad-based coverage and personal freedom, to say nothing of competing views about the respective roles of the market and the state (including different levels of government).
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President Trump cannot repeal the ACA by executive order. The ACA is a statute, enacted by Congress, which under the Constitution only Congress can repeal or modify. Furthermore, the order does not itself change existing regulations. Rather, it provides instructions or guidelines as to how Trump wants responsible agencies to exercise their discretion in interpreting and applying statutory requirements. The order appropriately recognizes that the new priorities it outlines can be followed by administration officials only “to the maximum extent permitted by law.”
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Democrats, hoping to seize on momentum from the apparent collapse of the Republicans’ health bill, are grappling with a tough question—whether they can do anything to prevent the Trump administration from weakening the Affordable Care Act through administrative actions by the Department of Health and Human Services.
Democrats are trying to mobilize public support to block potential changes. Five Democrats on the Senate health committee sent a letter to President Donald Trump Monday calling on him not to undermine the health law.
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It is valuable to understand what would happen if AHCA in fact became law, and what could be done to improve it or a new reform proposal. The best place to start is with the cost estimate of the plan produced by the Congressional Budget Office (CBO). Some have criticized CBO for this estimate, arguing that it is a fundamentally inaccurate assessment. While some of CBO’s assumptions are indeed questionable, there is little doubt that the agency’s bottom line assessment is basically correct: The bill, as currently structured, would trigger a rise in premiums in the short-run, a sharp increase in the number of people without insurance over the next two years, and then also a steady increase in the number of uninsured Americans over the following eight years. Instead of trying to discredit this finding, the authors of the legislation would be better off fixing the bill. CBO’s estimate provides a roadmap for what needs to be done to improve the chances the bill will produce the results its authors intend.
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The Trump administration indicated that it plans to continue the Affordable Care Act’s cost-sharing subsidies while they are part of ongoing litigation, one administration official said Monday, in what may be the clearest statement on the issue so far.
The precedent that the cost-sharing subdues would be funded while the lawsuit is being litigated remains the policy of the current administration, according to the official, who spoke on conditions of anonymity.
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The conventional wisdom—repeated by President Trump—is that the right-wing House Freedom Caucus is singlehandedly blocking Republican attempts to repeal and replace Obamacare. In fact, Freedom Caucus members have been reaching out to the larger bloc of “no” votes—GOP moderates—to find a path forward. Moderates are rebuffing them. The contours of a deal exist that could satisfy the concerns of both the House Freedom Caucus and GOP pragmatists. They involve replacing the AHCA’s flat tax credit with a means-tested one that focuses on offering assistance to the working poor, and pairing that change with rolling back more of Obamacare’s premium-increasing insurance regulations. But members of the Tuesday Group, the countervailing faction of House GOP moderates, are saying no to any phone calls from members of the Freedom Caucus.
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