A couple weeks ago, the House voted 51 to 48 to approve a budget blueprint that would set the stage for a reconciliation bill, a beginning to the process of repealing Obamacare. (Contrary to what several popular social media posts claimed, they did not vote at the time to repeal sections of Obamacare).
A budget blueprint is not presented to the president and does not become a law; rather, it serves as a guideline for Congress. A reconciliation bill is a type of legislation that would make it easier for Republican legislators to repeal sections of the Affordable Care Act (ACA) without the risk of a Democratic filibuster. It would also pave the way for Republicans to attack parts of the ACA that involve a cost to the government by stripping them of funding.
A repeal of the ACA seems very likely, since this vehicle, which only requires 50 Senate votes, is already underway. Representative Diane Black (R. -Ten.) said that key House committees would vote within two weeks on draft repeal legislation, and that the final reconciliation bill would be ready in late February or early March.
A replacement, however, which requires 60 votes, is much less certain. Republican legislators have proposed a slew of replacements for the ACA, but have yet to confirm a plan or set a timeline for executing it.
Tom Price (R. -Ga.) and Speaker of the House Paul Ryan (R. -Wis.) have proposed plans that would remove the mandates for individuals and businesses with 50 or more full-time workers to purchase health insurance. The government would offer tax credits to buy insurance in their place.
Cynthia Cox, associate director of the Kaiser Family Foundation, says a “continuous coverage” policy seems a likely proposal. Under this policy, anyone with a pre-existing condition would need to have no gaps in insurance coverage in order to avoid being denied by insurance companies. Most of the proposed replacement plans, in fact, are reportedly less friendly to people with pre-existing conditions.
Under various other proposals, younger consumers would likely pay less than they do now, while older consumers would likely pay more. Insurers would also be able to charge women more than men for coverage.
During the budget blueprint proposal, the Senate rejected all amendments brought forth by Democrats: clauses intended to allow prescription imports from Canada, protect rural hospitals and ensure access to insurance for those with pre-existing conditions. Democrats proposed these “messaging amendments” in order to advertise that Republicans were opposing popular parts of the ACA. As they well should — as I read more about how Republicans are undecided on a replacement plan and have no real consensus on a timeline for repeal and replacement, I become more and more worried.
Two schools of thought have arisen amongst Republicans in the ACA debate: “repeal and delay” and “repeal and replace.” GOP leaders contend that neither approach would leave Obamacare consumers without coverage.
The repeal and delay approach would repeal Obamacare as soon as possible. It would also delay key aspects of the repeal for a few years. The current system would continue for that time while a replacement is developed and passed.
Proponents of repeal and replace would rather repeal Obamacare immediately and pass a replacement bill soon after. President Trump has spoken in favor of this approach, saying that he has a replacement plan that is “less expensive and far better,” but will not reveal it until his pick for Health and Human Service, Tom Price, is confirmed. This plan seems to be favored by GOP leaders as the Senate and House rush into the repeal process.
This approach would certainly make sense for the GOP — that is, if there was a replacement plan. Lawmakers have questioned the current timeline. Sen. Susan Collins (R. -Ma.) said “I don’t see any possibility of our being able to come up with a comprehensive reform bill that would replace Obamacare by the end of this month.” Vice President Mike Pence at one point suggested that replacing the ACA could take up to two years.
Replacing the plan, which took years to become part of American healthcare and will likely take years to dismantle, on the GOP’s current timeline just doesn’t seem feasible. Due to the current lack of consensus on a plan or a timeline, I urge the GOP to adopt the repeal and delay approach.
The risks of quickly repealing the ACA without offering a comprehensive replacement plan are numerous. The Congressional Budget Office and the Joint Committee on Taxation released a report that said repealing parts of the ACA would increase the number of uninsured people in the US by 18 million during the first year new health care plans are enacted under the repeal. A recent study by the Commonwealth Fund and Rand Corp. found that without repeal, an individual ACA policy would cost $3,200 a year on average in 2018. With repeal, the average cost of a replacement policy would rise to $4,700.
Most importantly, loss of insurance coverage can lead to a loss of life. A comprehensive study from the New England Journal of Medicine found that for every 455 people who gained insurance coverage across several states, one life was saved per year. If that figure is applied to an estimated 20 million losing coverage in the event of a repeal, we can estimate 43,956 deaths annually due to lack of coverage.
These are serious consequences, and yet the GOP is still rushing to repeal and replace. It seems as though the urge to repeal is largely symbolic, and while that’s admittedly a smart political move for conservatives, it doesn’t bear in mind the best interests of the constituents.
I can recognize that there are some issues with Obamacare that need to be smoothed out — it’s extremely complex, difficult for the public to understand and costly to taxpayers. I don’t necessarily see an issue with repealing it as long as Republicans come through on their promise to offer a replacement plan that won’t leave the 20 million Americans who gained insurance under Obamacare without any sort of coverage. A common sense approach would be to not repeal the ACA until a replacement is solidly decided upon.
Since it appears that isn’t going to happen, I would urge Republican legislators to proceed with caution. The repeal and delay approach would afford Republicans the symbolic victory over Democrats (and specifically over former president Obama) of an instant repeal, while also avoiding an abrupt loss of coverage.
Republicans wouldn’t have to bear the political burden of that loss. More importantly, we would avoid the national-scale consequences of making a hasty decision on a policy that touches the life of nearly every American in some way.