The strategy that Congress and the Trump administration will pursue to repeal and replace the Affordable Care Act continues to evolve. In early January, the favored strategy seemed to be to repeal as much as possible of the ACA through legislation, but to delay the repeal of key provisions, such as the premium tax credits and marketplaces, for two or more years and then begin work on a replacement. In mid-January, this seemed to be giving way to an approach, apparently favored by the Trump administration, under which replacement legislation would be adopted more or less simultaneously with repeal, although it was not clear how this could take place without cooperation from Democrats, which seemed unlikely.
. . .
During the election campaign, Donald Trump promised to abolish Obamacare and replace it with better health reform that would not leave anyone behind. In order to understand what is implied by that promise, consider Figure I, which highlights three groups of people:
- About 11 million people are getting insurance in the exchanges and many of them are unhappy. In the words of former president Bill Clinton, many are “paying twice as much for half the coverage” they were previously enjoying.
- Another 11 million or so people are getting individual insurance outside the exchanges. These people have all the same problems as people in the exchanges. But, they receive no federal tax break for the purchase of insurance, even though a federal mandate requires them to buy it.
- In addition, about 29 million people are uninsured and that number is unlikely to change very much going forward. Polls show that the most important reason why so many people are uninsured is cost.
One way to think about Donald Trump’s campaign promise is to see that he wants to make health insurance less expensive and better for the first two groups without leaving the third group permanently uninsured. And he wants to do it with money that is already in the system. In other words, without raising taxes.
. . .
The pre-existing conditions issue played a central role in the design of the Affordable Care Act, and dealing with this issue appropriately in any ACA replacement plan will be instrumental to the achievement of stable and sustainable individual and small group health insurance markets.
House Speaker Paul Ryan and House Republicans’ June 2016 Better Way health care reform proposals, supported by Representative Tom Price, President-elect Trump’s nominee to head HHS, will surely influence the development of replacement legislation. Consistent with the Better Way, there would appear to be fairly broad support among Congressional Republicans for a replacement plan that at a minimum (1) guarantees that people who maintain continuous coverage can do so at terms that do not reflect health status, (2) provides substantial incentives for people to purchase coverage before needing costly medical care, and (3) provides some form of safety net for those who fail to purchase and maintain coverage.
. . .
Many Obamacare supporters claim the law has expanded health coverage to upwards of 20 million Americans, but new data shows that isn’t accurate.
As part of Congress’ continued push to repeal Obamacare, the House Budget Committee held a hearing this week titled “The Failures of Obamacare: Harmful Effects and Broken Promises.”
Heritage Foundation expert Ed Haislmaier was one of four expert witnesses who testified.
Haislmaier presented new data regarding gains in health coverage since the full implementation of Obamacare began in 2014.
. . .
While the final figures will be somewhat different once the more complete end of year data is available, at this point it is reasonable to expect that for the three-year period of 2014 through 2016, the net increase in health insurance enrollment was 16.5 million individuals. Of that figure, 13.8 million were added to Medicaid and 2.7 million were the net increase in private-sector coverage enrollment.
In general, enrollment data indicate that the implementation of the ACA appears to have had three effects on health insurance coverage: (1) a substantial increase in individual-market enrollment; (2) an offsetting decline in fully insured employer-group plan enrollment; and (3) a significant increase in Medicaid enrollment in states that adopted the ACA Medicaid expansion.
. . .
The Republican congressional leadership has made a new timetable for gutting the Affordable Care Act, aiming to get legislation done by March or possibly April.
But that doesn’t give insurers much time to meet their first deadline for submitting plans for 2018 on the individual market, which includes the law’s exchanges.
A rule published four days before President Trump took office set the deadlines for insurers to sell health plans on the individual market, which is for people who don’t get insurance through their jobs. Democrats have charged that Republicans will throw the market into chaos by repealing the law without an alternative, with Republicans responding that the markets are already in turmoil.
. . .
It’s an exciting time for our country. With a unified Republican government in place, the coming months are shaping up to be a busy time working to put real solutions in place to help the American people.
At the forefront of the agenda is repealing Obamacare and rebuilding our health care system in order to provide quality health care, at an affordable price, to the citizens of our country. It’s no small task, but one we are committed to doing — and doing right.
. . .
Republicans have been rolling out their suggestions for replacing Obamacare, providing lots of ideas for leadership to draw from but also highlighting intra-party divisions over how it should be done.
Some lawmakers want to provide people with tax credits to buy coverage, while others want deductions. Some House conservatives are suspicious of phasing out Obamacare gradually. And a growing group of senators are stressing that replace must happen at the same time as repeal.
The party is united around the idea that there must be some sort of healthcare reform, but it’s divided over how quickly to repeal the law, how long it should take to phase out and whether a replacement needs to be passed at the same time.
. . .
Tom Price, President Trump’s choice for secretary of Health and Human Services (HHS), has the distinction of being a better fit for the department he’s been picked to lead than any other Trump cabinet nominee. But this hasn’t helped Price gain Senate confirmation.
Price, 62, is an orthopedic surgeon. He ran an orthopedic clinic for 20 years in Atlanta before returning to Emory University, where he had finished his residency, as an assistant professor of orthopedic surgery. He also ran a clinic at Grady Memorial, Atlanta’s largest public hospital.
. . .
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.
. . .