Now that the GOP controls both houses in Congress as well as the presidency their threat to repeal the Affordable Care Act is no longer just a daily talking point. The part that is going to be hard for them is to change to a new system that does not take away things that 20 million Americans who have signed up in recent years.
President Obama’s signature legislative achievement was signed into law March 23, 2010, but didn’t come into full force until last year. Republicans hate the mandate that requires all adults to obtain coverage or face fines, they hate that the federal government has become the primary regulator of healthcare, and they hate that the law specifies what insurance companies need to cover.
REPEAL THE ACA
On Wednesday, Republicans said that they intent to repeal the ACA by early next year but might possibly delay the effective date 3 years in order to figure out what they want to replace it with. Part of this balancing act entails convincing the insurers not to bail out on the healthcare marketplaces.
House Republicans have voted 60 times to repeal the ACA since it was enacted. During the campaign, President-elect Donald Trump repeatedly said the law would be repealed and replaced with something “much better.”
After the election, Trump said that there were some elements of the ACA that should be preserved such as the guarantees of coverage for those with pre-existing conditions and allowing children on their parents’ plans until they are 26 years of age.
To make this even more complicated for the GOP is a study released by Kaiser Family Foundation that indicates only about a quarter of Americans want the law repealed entirely.
REP. TOM PRICE
Health Secretary-designate Rep. Tom Price, R-Ga., is a longtime critic of the ACA — and a doctor. Among the changes he has proposed, the Fiscal Times reported, are eliminating the state-run marketplaces, individual mandates and federal tax credits for low-income participants. Instead, he would like to see tax credits pegged to a person’s age, ranging from $1,200 to $3,000 to partially cover premiums and out-of-pocket costs.
PREVENT COVERAGE GAP
For a pre-existing condition or chronic illness to be covered, consumers would have to prove they had continuous coverage for the preceding 18 months to prevent people from obtaining coverage only after they become ill.
Senate Health Education, Labor and Pension Committee Chairman Lamar Alexander, R-Tenn., said he’d like to have a replacement plan in hand before the ACA is repealed, an approach favored by Price.
But House Speaker Paul Ryan said Wednesday he’s in favor of taking care of repealing the law immediately.
One approach under consideration is to take the law on in pieces rather than by passing one massive bill, an approach that likely would drag out the process and possibly produce a backlash from voters who want to see action after six years of bluster.
Ryan has offered a proposal he says would give patients and doctors more control and foster competition among insurers.
Like the ACA it would set up state insurance exchanges and protect those with pre-existing conditions. It also would auto-enroll people at points of service and give states the power to form multistate high-risk pools.
The proposal would provide tax credits for obtaining coverage and improve Health Savings Accounts by allowing premiums to be paid from them and increasing the amount of before-tax money that can be contributed to them.
The plan also calls for improvements to Medicaid and privatizing Medicare.