http://www.commonwealthfund.org/publications/blog/2017/jan/repeal-and-delay-budget-neutrality-aca-replacement?omnicid=EALERT1152052&mid=henrykotula@yahoo.com

As Congress considers options to repeal and replace the Affordable Care Act (ACA), it will need to confront how the federal budget scoring process can affect the fate of legislation. The Congressional Budget Office (CBO) is required to produce a “score,” or budget estimate, for most bills approved by a full committee in both the House of Representatives and the Senate. Each score represents CBO’s best estimate of the 10-year impact of legislation on the federal deficit. Bills scored as deficit-increasing may be difficult to pass given certain statutory and procedural rules intended to prevent new legislation from increasing the federal deficit.

Under the plans currently being discussed, repeal of the ACA’s coverage expansions may be delayed for two to three years to avoid immediately ending coverage for the 20 million people who became newly insured through the ACA.¹ Another rationale for the potential delay is to allow Congress time to coalesce around a single replacement policy. Yet the repeal-and-delay approach could also set up a budgetary cliff by taking credit for the savings and leaving the costs of any replacement for future legislation.

CBO evaluates legislation relative to a baseline that reflects existing law. Under a repeal-and-delay approach, Congress would partially repeal the ACA in 2017 using budget reconciliation, a process that allows expedited consideration of legislation that affects the federal deficit. To do so, the House and the Senate would need to pass a budget resolution requiring Congress to reconcile the budget to achieve specific changes to revenues or spending. (So far, the Senate has passed such a resolution.) Congress could then repeal provisions of the ACA that directly affect the federal budget, including federal funding for Medicaid expansion and marketplace tax credits, with a simple majority of votes, avoiding the potential of a filibuster in the Senate.

With this approach, lawmakers would be able to act quickly and decisively on a key promise made by president-elect Donald Trump, namely to repeal the ACA within the first 100 days after taking office. But disagreement among lawmakers about appropriate replacements for the ACA could cause disruption for insurers and health care providers, who would face uncertain regulatory and marketplace environments.

Moreover, the repeal-and-delay approach could make it difficult for any replacement legislation to be budget neutral. In a score of a previous partial repeal bill, H.R. 3762, CBO projected that repealing the coverage provisions in the ACA would reduce federal spending by $1.4 trillion between 2016 and 2025. Once repealed, the savings associated with eliminating the ACA’s coverage expansions would be part of current law and hence the baseline budget. This means that a future replacement bill could be scored as deficit-increasing, even if it cost less than $1.4 trillion.

http://www.healthcarefinancenews.com/news/advocates-lawmakers-laud-policy-changes-curb-death-fees-imposed-my-medi-cal

President-elect Donald Trump and Congressional Republicans have made clear their intentions to repeal the Affordable Care Act, but a new analysis from the Commonwealth Fund finds that repeal, without a replacement, would result in a $140 billion loss in federal funding for healthcare in 2019, leading to the loss of 2.6 million jobs, most of them in the private sector.

Without replacement policies in place, there would be a cumulative $1.5 trillion loss in gross state products and a $2.6 million reduction in business output from 2019 to 2023, the analysis shows. The state, and healthcare providers, would be particularly hard-hit.

Congress and the new administration would likely begin by targeting the ACA’s insurance premium tax credits and the expansion of Medicaid eligibility. Commonwealth’s research shows that the loss of those two provisions would double the number of the uninsured, cause higher uncompensated care costs for providers and hike taxes for lower-income Americans.

Healthcare will comprise almost one-fifth of the nation’s economy by 2019, so major changes to the healthcare landscape would reverberate across other parts of the economy.

To track this, Commonwealth analyzed funding flows from the federal government to states, consumers and businesses. Federal tax credits first flow to health insurers. Most of that money, aside from overhead, goes to hospitals, clinics, pharmacies and other providers. Those are the direct effects of federal funding.

Most of the revenue earned by providers is used to hire staff and pay for goods and services, like clinic space or medical equipment. In turn, those vendors pay their employees, and additional goods and services. Those are the indirect effects.

Lastly, the workers use their incomes to pay for food, mortgages, rent, transportation, etc., which provides income to other business and industries. Those are the induced effects. When federal funds are cut, it triggers losses in employment and economic activity.

How Will The Planned Repeal Of Obamacare Affect Californians?

As federal lawmakers debate the fate of Obamacare this month, health coverage for millions of Californians hangs in the balance.

Covered California, the state health insurance exchange, and the expansion of Medi-Cal, the state’s Medicaid program for low-income residents, are products of the Affordable Care Act. Both could be at risk if the GOP-led Congress and President-elect Donald Trump gut key pieces of the health law.

Earlier this week, California Healthline Senior Correspondent Emily Bazar discussed the future of Obamacare coverage in California on Valley Public Radio’s Valley Editionprogram.

So far, answers remain elusive.