Healthcare Triage News: Republicans’ Many Plans to Replace Obamacare

https://morningconsult.com/2016/12/02/house-republicans-warn-not-expect-aca-repeal-day-one/

House Speaker Paul Ryan discussed a path to repeal and replace the Affordable Care Act during a closed-door conference meeting with House Republicans on Friday

“The speaker walked members through the process for delivering on our promise of repealing and replacing Obamacare,” AshLee Strong, a spokeswoman for Ryan, said in a statement. “Hetold members this is one of the President-elect’s top priorities for Congress and one of the first things we will do in the House.”

Rep. Tom Cole (R-Okla.), who sits on the House Budget Committee, said the Senate will likely act on a budget resolution early next year, before sending it to the House, where committees will begin work on what will become a reconciliation package. In the House, the Ways and Means and Energy and Commerce committees are expected to play major roles in the repeal and replacement of the 2010 health care law.

While a formal timeline hasn’t been laid out, Cole guessed a bill repealing the law may be passed in February.

“It takes a little while to actually both work out exactly what you can do on reconciliation because there’s a lot of individual decisions the Senate parliamentarian makes, and then you’re going to be moving the replacement piece as well, and that takes real committee work,” he told reporters Friday.

While lawmakers plan to use reconciliation, a budget tool that allows the Senate to pass certain provisions with a simple majority of 51 votes to repeal the law, they likely won’t be able to pass a replacement through that process. Reconciliation itself will repeal the bulk of the ACA, but not the bill in whole.

Republicans have also raised concerns about trying to move too quickly on Obamacare, with some wary of setting a policy that could fail.

“This whole process will be done thoughtfully as we move forward with this,” Rep. Tim Murphy (R-Pa.), who hopes to chair the Energy and Commerce Health Subcommittee during the next Congress, told reporters Friday. “We do not want to move in haste, as was done before, and make a lot of errors.”

https://www.brookings.edu/research/repeal-and-replace-obamacare-what-could-it-mean/?utm_campaign=Economic+Studies&utm_source=hs_email&utm_medium=email&utm_content=38788605

Donald Trump’s pledge to “repeal and replace Obamacare” was one of his biggest crowd pleasers. It’s been noted, of course, that “repeal and replacing” is easier said than done, and indeed the President-elect has already begun to fudge. But moving forward on his broad replacement themes—expanding health savings accounts (HSAs) and state flexibility—could lead to some surprising and intriguing reforms.

Some have argued that Trump could and should strike a devastating blow to the Affordable Care Act (ACA) on his first day in office. For instance, he could decide not to appeal the lower court ruling in House v Burwell. A federal district court has ruled that that money cannot be spent on cost-sharing subsidies because Congress has not appropriated the money. So dropping the appeal would mean the end of these payments. In similar vein, he might demand repayment from insurers of billions of dollars of transitional reinsurance payments, citing a recent General Accountability Office letter declaring that the Administration lacks the legal authority to reassign to health plans some funds intended by statute for the US Treasury’s general fund.

Such first-day actions would destabilize the exchange plans, causing more insurers to withdraw and shredding the subsidy system. Even allowing a 1- or 2-year phase-out would gravely disrupt the exchange system. Yet the high cost of premiums and deductibles was the chief complaint about Obamacare among Trump supporters. In addition, the Trump surge was strongest in counties characterized by poor health. These voters would be outraged by even higher out-of-pocket costs and fewer plans.

To avoid a backlash, repeal and replace must be a measured and slower process. That’s true even if much, or all, of the restructuring could be accomplished through budget reconciliation, a budget process maneuver that would avoid a filibuster by Senate Democrats. Moreover, a replacement does not need to be nationally uniform. Republicans, long dismissive of “one-size-fits-all” solutions from Washington, should recognize that what will work in Texas and Utah may not be right for California and Massachusetts.

So, in broad terms, how might the stated themes of repeal and replace evolve?