The first major act of the unified Republican government in 2017 will be a vote in Congress to begin tearing down Obamacare.
But the euphoria of finally acting on a long-sought goal will quickly give way to the reality that Republicans -- and President-elect Donald Trump -- have no agreement thus far on how to replace coverage for about 20 million people who gained insurance under the health-care law.
“They haven’t come to a consensus in the House and the Senate about the possible replacement plans,” said Douglas Holtz-Eakin, a conservative economist and former adviser to Senator John McCain’s 2008 presidential campaign. “They don’t know Point B.”
Republicans are debating how long to delay implementing the repeal. Aides involved in the deliberations said some parts of the law may be ended quickly, such as its regulations affecting insurer health plans and businesses. Other pieces may be maintained for up to three or four years, such as insurance subsidies and the Medicaid expansion. Some parts of the law may never be repealed, such as the provision letting people under age 26 remain on a parent’s plan.
House conservatives want a two-year fuse for the repeal. Republican leaders prefer at least three years, and there has been discussion of putting it off until after the 2020 elections, staffers said.
QuickTake Q&A on How Republicans Might Try to Repeal Obamacare
In nearly seven years since Obamacare passed, dozens of comprehensive health-care alternatives have been introduced, but none has gotten off the ground. The most developed plan so far is legislation by House Budget Chairman Tom Price of Georgia, Trump’s nominee to run the Department of Health and Human Services, which he introduced in every Congress since 2009. It had 84 cosponsors in the House.
But that bill -- centered on age-based refundable tax credits to buy insurance -- didn’t receive a hearing in committee, nor was it included in Price’s budget that was adopted by the House last year.
If Republicans stick together, repeal could happen quickly. The Senate plans to move first on a nonbinding budget resolution instructing committees to draft repeal legislation, with the House approving it next. The resulting proposals would be sent for final votes under a process known as reconciliation, which is used to bypass the 60-vote threshold in the Senate.
Key players tasked with executing the plan will be Senate Finance Chairman Orrin Hatch of Utah and Health Chairman Lamar Alexander of Tennessee, and on the House side, Ways and Means Chairman Kevin Brady of Texas and incoming Energy and Commerce Chairman Greg Walden of Oregon.
Replace With What?
To cushion the political blow of upending the system, party leaders are putting out a stream of statements portraying Obamacare as collapsing on its own.
But the Department of Health and Human Services reported that signups reached 6.4 million by the Dec. 19 deadline, an increase of 400,000 over the previous year’s number at this time. Earlier, President Barack Obama said that more than 670,000 Americans signed up for coverage on Dec. 15, "the biggest day ever for Healthcare.gov."
“The overarching challenge is that the Affordable Care Act is the status quo, and disrupting the status quo in health care is always controversial,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation and former adviser to President Bill Clinton’s health-care efforts. “There are so many moving pieces to this effort involving lots of money and lots of interest groups. So piecing together the votes is daunting.”
Trump and House Speaker Paul Ryan of Wisconsin have been vague on what they want to see, but both released blueprints calling for expanding the use of tax-advantaged Health Savings Accounts, allowing the sale of insurance across state lines and turning Medicaid over to states. Republicans are seeking recommendations from governors and industry leaders on what to do.
“We need to put patients in charge of their health-care choices with a free-market solution that increases access and lowers the overall spiraling costs of health care, which Obamacare did nothing to address,” Republican Senator David Perdue of Georgia, a close Trump ally, wrote Thursday in an op-ed for the Daily Caller, a conservative website.
Translating slogans and white-papers into legislation will create problems. Undoing Obamacare would increase the number of non-seniors who are uninsured by 24 million over a decade, according to the Congressional Budget Office. Republican aides privately acknowledge that would give Democrats a potent political weapon to fight their efforts, but say their focus will be on lowering costs and expanding choice.
Trial and Error
Unifying the party may require trial and error, said Rodney Whitlock, a former health policy aide to Republican Senator Chuck Grassley of Iowa, adding that Ryan will be a key figure to watch. He may have to get the Congressional Budget Office to provide estimates for how multiple proposals would affect the budget deficit, Whitlock said.
“That’s the pathway to get his folks to understand the cost and coverage consequences of their policy decisions,” Whitlock said. “That’s not going to be easy, but I don’t see how he gets his conference to consensus without an exercise like that.”
Some Republican aides say they may pursue a replacement through a series of small bills as opposed to one big measure. Leading Republicans such as Senate Majority Whip John Cornyn of Texas have said they want Democratic buy-in on a replacement plan. Breaking a filibuster would require the support of at least eight Democrats.
Obamacare continues to be viewed unfavorably by Americans, but the politics of undoing the law are complicated. A Kaiser Family Foundation poll after the election showed 26 percent want to repeal it, while 17 percent want to scale it back. Nineteen percent want to move forward with implementation and 30 percent want to expand it.
‘Bring It On’
Democrats have made clear they won’t go along with Republican attempts to repeal Obamacare. Some are taunting the GOP as it attempts to write a replacement.
“Bring it on,” incoming Senate Democratic Leader Chuck Schumer of New York said this month. “They don’t know what to do. They’re like the dog that caught the bus.”
Several of the law’s provisions are popular, most notably the regulations prohibiting insurers from denying coverage or raising costs on people with pre-existing conditions. And of the 14 states with the largest percentage of non-elderly people with pre-existing conditions in 2015, Trump carried 12, according to a Kaiser Family Foundation study released last week. He also got one electoral vote in Maine, the 13th state in that group.
Congressional Republican aides say they’re likely to soften those rules by limiting their protections to people who maintain continuous coverage.
“The pre-existing condition provisions in Republican proposals are less protective,” Levitt said. “With fewer protections you could piece together other mechanisms to keep the market stable.”
Trump has proposed high-risk pools to cover sick uninsured people, but financing them will be a challenge. A 2010 estimate in National Affairs by conservative health-care experts Tom Miller and James Capretta pegged the cost at $150 billion to $200 billion over a decade to insure up to 4 million people; House Republicans have been reluctant to spend anything close to that.
Republicans are considering setting up a fund to address the cost, perhaps with savings from repealing Obamacare’s subsidies.
The funding challenges are substantial. Repealing the law would increase the deficit by $353 billion over a decade, or $137 billion under favorable macroeconomic assumptions, according to the Congressional Budget Office.
As they chart the path ahead, Republicans are trying to calm fears.
“The new big lie, after ‘if you like your health care plan you can keep it,’ is that 20 million Americans will lose their health care. That’s simply not true,” Brady told reporters Dec. 15. “Republicans will provide an adequate transition period to give people peace of mind that they will have those options available to them as we work through the solutions.”
Source: Bloomberg (via HuffPost)
OBAMA WILL MEET WITH CONGRESSIONAL DEMOCRATS ON STRATEGY TO BLOCK OBAMACARE REPEAL
WASHINGTON ― President Barack Obama will huddle with House and Senate Democrats next week to strategize on how best to protect the Affordable Care Act.
Republican lawmakers plan to take up a repeal of Obamacare as soon as Congress returns in January.
“Next week, Republicans in Congress will once again turn to repealing a law that’s provided coverage to 20 million uninsured Americans, extended consumer protections to many millions more, improved the quality of care offered by our health professionals, and helped slow the growth of health care costs,” a White House official said in a statement. “In light of this, on Wednesday, January 4, President Obama will visit a meeting of the House and Senate Democratic Caucuses.”
The official added that Obama will thank the members for helping advance the health care system.
“He will discuss the work still left to do, including the ideas he has put forth to strengthen the Affordable Care Act (ACA). And he will share his perspective about the dangers posed by Congressional Republicans’ stated strategy to repeal the ACA before proposing any replacement, creating chaos in the health system in the short run ― and holding hostage Americans’ health care ― while Republicans develop their plan,” the official said.
A senior Democratic Senate aide confirmed that the meeting would be about the party’s “fight against GOP repeal efforts.”
Democratic leaders have been defiant about Republicans’ chances of pulling off this effort. House Minority Leader Nancy Pelosi (D-Calif.) predicted that Republicans would not repeal Obamacare once they realized how difficult it would be to replace.
“They’re not going to repeal it,” Pelosi said earlier this month. “I don’t think they’re going to repeal the Affordable Care Act.”
In a letter sent to House and Senate Democrats last week, congressional leaders are advising their members to prepare for a national day of action against repeal efforts on Jan. 14 in coordination with governors. House members were directed to plan press events on Jan. 7 to highlight the risks of undoing Obamacare.
Still, the GOP is rushing forward and party leaders are unanimous about scrapping the law. The American people, however, aren’t exactly enthused about the idea, according to a post-election survey by the Henry J. Kaiser Family Foundation. Only about one-quarter of Americans favor fully repealing the Affordable Care Act, while nearly half want to leave it in place or expand it.
As for what guidance Obama may be able to give congressional Democrats about how to stop, or even influence the direction of, the GOP’s repeal-and-delay strategy, that isn’t easy to imagine.
Republicans control both chambers of Congress. Democrats have virtually no tools at their disposal to alter the House’s direction on health care. And in the Senate, Republicans plan to use the budget reconciliation mechanism ― which allows a measure to pass with a simple majority and can’t be filibustered ― to knock out the biggest parts of the Affordable Care Act early next year.
Reconciliation bills are limited to changing laws that affect taxes and spending, which covers key elements of Obamacare. The health care reform law raised taxes on wealthy individuals and health care companies and cut Medicare payment rates to medical providers in order to finance new spending on health benefits.
The GOP’s current plan is to move swiftly on repeal legislation and then spend up to four years developing a consensus on a new set of health care reforms ― an achievement that has otherwise eluded the party for years. But Republicans are already split over how long they’ll spend creating that replacement. Party leaders expect it to take years, but some conservatives are pushing for a replacement to be finished within one year.
Based on the White House’s description of Obama’s planned visit to Capitol Hill, it seems the outgoing president aims to give his beleaguered party a pep talk and to remind them why they paid such a high political price over the past six-plus years. The Affordable Care Act attempted to fill the biggest hole in the social safety net and succeeded in driving down the uninsured rate to the lowest level ever recorded.
Whatever Obama might have to tell them, congressional Democrats already have laid out their strategy for the Obamacare repeal vote: highlight the human cost of ripping away health coverage from as many as 30 million people, and point to the GOP’s longstanding inability to agree on what they really want to accomplish instead.
Their best hope is that Senate Democrats can use their sizable minority to obstruct GOP health proposals over the next few years and to exert pressure on Republican senators who, looking to their own re-election chances, have concerns about the disruption that would be caused by repealing most of Obamacare without a “replacement” for three to four years.
Democrats can also highlight fresh evidence that the Affordable Care Act is emerging from its initial troubled period and that the health insurance exchanges, where individuals and families shop for coverage and apply for financial assistance, may be improving.
Enrollment during the current period, which ends Jan. 31, appears to be outpacing last year’s, the Obama administration announced this month. And after losses had led insurers, including UnitedHealth Group, to scale back their participation in the exchanges, the financial ratings company Standard & Poor’s recently reported that the financial picture for insurers on the exchanges is getting better.
Sounds like we'd all better get ready to start calling and writing our Senators and Congress critters until they get sick and tired of hearing from us. *weary sigh*
I would say I can't believe these douche nozzle Republicans think they can get rid of Obamacare when they don't have a fucking clue what to replace it with--but ever since the orange baboon got his ass elected, there's not much left that I don't believe is possible. God dammit.