Congress is crafting new legislation to repeal and replace the Affordable Care Act (ACA) after House Republican leaders canceled a vote on their plan, the American Health Care Act (AHCA), due to inadequate support.
Opposition from the conservative House Freedom Caucus and the centrist Republican Tuesday Group led House Speaker Paul Ryan (R-WI) to cancel a vote on AHCA scheduled for March 24. One day earlier, President Donald Trump had signaled his intentions to move on from AHCA to other legislative priorities, such as tax reform and border security.
In a press conference on March 28, Ryan said his party and chamber would “get this right” because “Obamacare is doing too much damage to families.” House Majority Whip Steve Scalise (R-LA) said at the same conference, “I think we’re closer today to repealing Obamacare than we’ve ever been before.”
Ryan had called AHCA “the closest we’ll ever get to repealing and replacing Obamacare” on March 9.
Rep. Mark Meadows, chair of the House Freedom Caucus, says a bloc of conservatives would vote for AHCA if amended to repeal Obamacare’s essential health benefits (EHB) mandate and community rating requirement, the Washington Examiner reported on March 31.
“The Freedom Caucus has asked for two [more mandates] to be included in the repeal, which would bring us to a total of four of the 12 Obamacare mandates,” Meadows said. “That’s our ask: These Obamacare mandates repealed in exchange for Yes votes.”
Obamacare’s EHB mandate increases the cost of insurance by requiring plans to cover 10 medical needs specified by law, including maternity and newborn care, treatment for substance abuse disorders, and outpatient services. The community rating mandate requires insurers to sell plans at the same price to individuals of similar ages and locations, even if some of those individuals are riskier than others to insure.
In addition to keeping these mandates, the March 24 version of AHCA would have given individuals $2,000–$4,000 tax credits with which to buy insurance.
Other Republican Contenders
Chad Yelinski, Meadows’ legislative assistant, says Meadows also supports legislation to replace Obamacare more fully than AHCA would.
“I can say he’s still supportive of Rep. Sanford’s Obamacare Replacement Act,” Yelinski said. “Rep. Meadows supports a full repeal of the ACA. However, he has not signed on as a cosponsor of Rep. Brooks’ bill, as of now.”
Rep. Mo Brooks (R-AL) introduced the Obamacare Repeal Act, which would scrap ACA in a single sentence, on March 24, the day House leadership canceled the vote on AHCA.
“Effective as of December 31, 2017, the Patient Protection and Affordable Care Act (Public Law 111–148) is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted,” the bill states.
The Obamacare Replacement Act, sponsored in the House by Rep. Mark Sanford (R-SC) and in the Senate by Sen. Rand Paul (R-KY), would repeal Obamacare’s EHB and community rating mandates and give taxpayers a nonrefundable tax credit up to $5,000 to spend on health care and insurance.
Libertarian-leaning Rep. Thomas Massie (R-KY), a vocal opponent of AHCA, is open to any bill fully repealing ACA, says Jennifer Krantz, Massie’s press secretary.
“Congressman Massie is in support of any plan that is a clean repeal of Obamacare,” Krantz said. “It’s our understanding that Steve King also has an Obamacare repeal bill.”
The bill offered by Rep. Steve King (R-IA) is also one sentence, proposing to repeal Obamacare immediately instead of on December 31, 2017, as Brooks’ bill specifies.
Dr. Jane Orient, president of the Association of American Physicians and Surgeons, says the Republican congressional leadership has unnecessarily complicated ACA repeal.
“The simplest way for Republicans to keep their word is just to repeal,” Orient said. “Then they can work on targeted solutions to problems that are identified.”
Designed for ‘Swamp Dwellers’?
AHCA would have doubled down on Obamacare’s flaws, leaving Republicans to blame for the failures of each law, Orient says.
“It appears that AHCA was designed to mollify the swamp dwellers who lobbied for ACA in the first place,” Orient said. “I don’t know what Ryan’s strategy could have been: pretend to repeal and replace while cementing the flawed assumptions in place and hoping he could still blame the Democrats?”
The next bill Republicans propose should not herd patients into insurance plans made more expensive by government mandates, Orient says.
“Guaranteed issue and community rating were already shown in the ‘laboratories of democracy,’ such as New York and New Jersey, to destroy the individual insurance market,” Orient said. “The paradigm of comprehensive third-party payment needs to be trashed and replaced with sound economics, with people in charge of their own money.”
Passing AHCA was phase one of three in Ryan’s strategy to replace Obamacare. Phase two would have relied on Health and Human Services Secretary Tom Price (R-GA) to roll back additional ACA regulations. Phase three would have had Congress enacting various other health care reforms.
Seth Chandler, a visiting scholar at the Mercatus Center at George Mason University, says Ryan’s strategy would have left Republican health care reform bills exposed to a Democrat filibuster.
“It’s hard for me to see how the Republicans were ever going to get phase three through without either significant Democratic support, which looked ever less likely, or overruling the parliamentarian,” Chandler said.
Orient says phase three seemed like merely a sales pitch for phases one and two.
“Phase three looked like a ruse to me,” Orient said. “Why would the wonderful proposal get 60 votes later, but not now?”
Republicans may find it easier to replace Obamacare the longer the current system continues to fail, Chandler says.
“People need to really see or believe that the ACA is collapsing, and it would be an easier sell if President Trump did not aggressively sabotage the act,” Chandler said. “Alternatives to the ACA will look a lot better once the unsustainability of the ACA becomes clearer.”
Michael T. Hamilton ([email protected], @MikeFreeMarket) is a Heartland Institute research fellow and managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.
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