The Shifting Sands of ACA Repeal and Replace

By Joel Miller posted 03-10-2017 15:28

Although the House Republican Leadership Bill to Repeal and Replace the Affordable Care Act (ACA and also known as Obamacare) has drawn a barrage of criticism – including moderate and conservative Republicans -- since it was introduced this week, the GOP House leaders intend to keep moving the bill forward and quickly.

Pursuing an aggressive timeline to have both chambers clear the legislation before the Easter recess in April -- with the goal to have a final bill in President Trumps hands to sign – the Republicans took a major step in that direction when the House Ways and Means Committee overturned wide swaths of the ACA in a markup Thursday morning, advancing their part of a House bill on a party-line vote of 23-16.

Next week the full House will probably vote on a combination of the House Budget Committee bill and another repeal measure the House Energy and Commerce Committee oversees.

Democrats also pressed Republicans on why they are trying to ram the bill through with no hearings or expert witnesses, unlike the extensive hearing process preceding passage of the ACA in 2010.

Democrats stressed the likelihood that the bill's reduced premium tax credits and Medicaid spending cuts would increase the nation's uninsured rate, hurt vulnerable populations such as people with mental illness who have gained coverage through the ACA, drive up uncompensated care and cause hospitals to lay off health care workers.

With the sands constantly shifting within the Republican caucus concerning the overall repeal process and specific bill language, the House GOP plan is drawing concern and even opposition from both conservative and moderate lawmakers. The plan is also highlighting the divide among some GOP governors -- especially those in states that chose to pursue the ACA’s Medicaid Expansion Program that has provided health insurance to 11 million people – and congressional leaders.

Moreover, the measure, in its current form, could face challenges when it reaches the Senate, where Republicans have a slimmer margin of victory. The bill would not pass if three Republicans Senators defect.

House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell (R-Ky.) are trying to build momentum to fast-track the legislation pass the growing groundswell of opposition not only from Democrats and small-government minded Republicans, but also from major health care associations and private sector stakeholders groups who have created an unlikely coalition against the GOP plan such as the American Hospital Association, American Medical Association, AARP, and America’s Health Insurance Plans (AHIP).

Despite all the opposition from various corners, repeal and replace was a promise made during the campaign by President Trump and GOP leaders. They appear to be steadfast in that pledge.

But many legislative colleagues are saying slow down and do this thing right.

We’ll see if their calls for patience are heeded.