Daily Local News (West Chester, PA)
Easier said than done
Republicans may soon repeal Obamacare, but a replacement plan remains unclear
The Patient Protection and Affordable Care Act was signed into law by President Barack Obama in March of 2010, after passing in the Senate and House of Representatives without a single ‘yes’ vote from a Republican lawmaker. Republicans have
long talked about repealing and replacing Obama’s signature health care law – commonly referred to as the ACA or simply Obamacare – and they may now be able to accomplish that goal without any support from Democratic legislators.
Republicans are closer than ever to repealing the ACA, with majorities in both chambers of Congress, and an incoming Republican executive, Presidentelect Donald Trump, who is set to move into the White House next week. However, repealing the ACA is one thing, but replacing it could be an entirely different story.
During his presidential campaign, Trump said he would repeal and replace Obamacare, but he did not offer specifics on what exactly he would replace it with. Most Republicans are united in their opposition to Obamacare, but they are not all in agreement about how and when it should be replaced.
In a flurry of action this past week in the U.S. Senate and House, Republican lawmakers have already started the process of repealing Obamacare by passing a budget resolution in both chambers of Congress.
On Friday, the House of Representatives began the process of dismantling the ACA, by approving the budget resolution which the Senate had approved the previous day. The resolution allows Republicans on Capitol Hill to use a process known as “budget reconciliation” to roll back major parts of the health care law. Most lawmakers voted along party lines on the resolution: no Democrats voted ‘yes,’ but one Republican senator and nine Republican representatives voted ‘no,’ including two from Pennsylvania.
Changes under Obamacare
The passage of the ACA brought about major changes in the health care industry. The ACA prevents insurance companies from denying coverage to people who have pre-existing conditions, and it allows young people to stay on their parents’ health insurance plans until they turn 26.
The ACA also implemented government subsidies to help low-income Americans afford health insurance. The controversial individual mandate in the ACA requires most Americans to have health insurance, either through a plan offered by their employer, a plan of a family member, or a plan from the public insurance marketplace on HealthCare.gov, but individuals who can afford health insurance and choose not to buy it must pay a fine.
Another aspect of the ACA was the expansion of Medicaid, but a Supreme Court ruling determined that it was up to the states to decide whether or not to expand Medicaid. Former Republican Gov. Tom Corbett received federal approval for a custom Medicaid expansion program called “Healthy PA” in the summer of 2014, but current Democratic Gov. Tom Wolf scrapped Healthy PA after he took office in January 2015, and instead launched a traditional Medicaid expansion for Pennsylvania shortly thereafter.
It’s estimated that more than 1 million Pennsylvanians currently receive medical coverage either through Medicaid or from a health insurance plan purchased on HealthCare. gov. According to the Wolf administration, there are about 670,000 Pennsylvanians covered under Medicaid expansion. Last year, about 439,000 Pennsylvanians selected health insurance plans from HealthCare.gov, and 333,640 of them received subsidies to help pay for the insurance, according to the Wolf administration.
Area representatives weigh in
Several Republican congressmen from southeastern Pennsylvania seem to be in agreement that the ACA should be repealed, but there should be a smooth transition period for a replacement.
Rep. Pat Meehan, R-7, of Chadds Ford, Delaware County, said in an email that Obamacare is broken, and that monthly premiums and out-of-pocket costs are soaring and patients are being forced to drop the doctors they trust.
“We need to repeal what’s not working and advance real, bipartisan reform that makes quality care affordable and accessible for every Pennsylvanian,” Meehan said. “We’re going to do it by putting patients first, cutting bureaucracy, and getting Washington out of the way of you and your doctor. We’re not going to pull the rug out from underneath Americans already on the Obamacare exchanges and we’re going to provide a period of transition over the next few years to ensure no family falls through the cracks.”
Meehan voted for the budget resolution to repeal the ACA.
Rep. Ryan Costello, R-6, of West Goshen, Chester County, said in an email that the ACA has resulted in higher out-of-pocket costs for families, less access for patients, and a more expensive and complicated healthcare system than existed before it was implemented, and that premiums continue to soar, while insurance companies are leaving the exchanges.
“The situation is only going to get worse if we pretend that the ACA is working,” Costello said. “The way to improve our health care system is to focus on making coverage more affordable, empowering patients with greater choice and flexibility, and expanding access for care, while protecting those who currently have coverage, especially those with pre-existing conditions.”
He said these improvements for creating an affordable health care system can only occur by: reducing the role of Washington, D.C. bureaucrats and the ACA’s mandates on doctors and patients; bringing about more transparency in what the actual cost of health care services are and by inviting more competition in the health insurance marketplace; encouraging greater innovation in health care, enhancing program integrity, and taking common-sense steps such as medical liability reform.
“My focus is going to be on ensuring a stable healthcare system, as we clean up many of the damaging impacts caused by the ACA, and working to achieve these objectives that are so important to the health and security of families and businesses across Pennsylvania and our country,” Costello said.
Costello voted for the budget resolution to repeal the ACA.
Rep. Brian Fitzpatrick, R-8, of Middletown, Bucks County, said in an email that any changes or improvements to the current health care system must ensure both the continuity of coverage and the continuity of patient protection provisions, and should be undertaken in a bipartisan fashion.
“Too much of the debate surrounding the ACA has been on buzz words and slogans: repeal, defund, delay, replace, fix, reform,” Fitzpatrick said. “What needs to be at the center of any discussion on health policy is the common goal of expanding coverage, improving quality and lowering costs.”
Fitzpatrick voted against the budget resolution to repeal the ACA.
Pa. senators on different sides of the issue
Pennsylvania’s two senators have opposing views about the future of the ACA. Democratic Sen. Bob Casey has previously voted against bills that would repeal the ACA, and Republican Sen. Pat Toomey has voted in favor of these bills.
“Repealing the Affordable Care Act without a plan to replace it is a recipe for disaster for families across Pennsylvania – the number of uninsured would double and close to a million Pennsylvanians would lose their coverage,” Casey said in an email. “Congressional Republicans are more concerned with cutting taxes for millionaires and big corporations than worrying about the people across our state with preexisting conditions, those who rely on Medicaid, and seniors struggling to pay for prescriptions. I intend to fight to ensure the safety of quality health care for these Pennsylvanians.”
Casey voted against the budget resolution to repeal the ACA.
Toomey’s press secretary, Steve Kelly, said in an email that “Sen. Toomey knows we must begin the process of repealing Obamacare. The heart of Obamacare — the individual health care market — is failing. Insurers are abandoning the market, premiums are skyrocketing, and people have lost the coverage they were promised they could keep. He has said he wants to move quickly toward a system that gives Americans more affordable choices in coverage.”
Kelly said Toomey supported the Obamacare repeal bill in December 2015 that provided for a twoyear transition before phasing out Medicaid expansion and premium tax credits. “Sen. Toomey has said repeatedly that taxpayer subsidies should be maintained for a period of time as we transition to a better health care system that gives families and individuals affordable choices in coverage, and takes Washington bureaucrats out of the doctor’s office,” Kelly said.
Toomey voted for the budget resolution to repeal the ACA.
‘Repeal and replace’
Although Republicans have the simple majorities needed in Congress to advance a repeal bill to the president’s desk, a replacement bill would likely be more complicated because virtually all Republican legislators would have to agree on the replacement. Furthermore, Republicans would have to figure out what to do with Medicaid if the ACA is repealed.
When Trump was eyeing a run for president, he vowed that he would not cut Medicaid. “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. (Mike) Huckabee copied me,” Trump said in a tweet on May 7, 2015.
Some suggestions Republicans in Congress have proposed to be included in a potential health care law to replace the ACA are: increased use of Health Savings Accounts (HSAs), which allow users to set aside money in a tax-deductible savings account to be used exclusively for medical costs; permit insurance companies to sell policies across state lines; get rid of the individual mandate; and enable individuals to join together in large insurance pools.
At a news conference in New York City Wednesday, Trump said the ACA will be repealed and replaced “essentially simultaneously.” “It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day. Could be the same hour,” he said.
Trump said he would be working with Congress on submitting a plan to repeal and replace the ACA as soon as the Senate approves his pick for Health and Human Services secretary, Rep. Tom Price, R-Ga., whose confirmation hearings are set to begin next week.
While the process of repealing the ACA has already begun, the logistics of Republicans coalescing around a bill or package of bills to replace the ACA may take months or even years. Some Republicans have expressed skepticism about repealing the ACA without a replacement ready to be voted on.
Rep. Charlie Dent, R-15, of Allentown, Lehigh County, told NBC News earlier this week that it would be “unwise” for Republicans to move forward on repealing the ACA if they don’t have a replacement plan. Dent voted against the budget resolution to repeal the ACA.
“I believe it is a fair state-
ment to say that there is a diverse cross-section of the House Republican Conference who feel, as I did, that replacement should occur simultaneously of a repeal,” Dent said in a telephone interview
with NBC. He said it is “careless” to simply “hope for the best” after a repeal, according to the report on nbcnews.com.
Sen. Rand Paul, R-Ky., wrote in an op-ed on rare. us that Obamacare should be repealed, but partial repeal would only accelerate the current chaos and may eventually lead to calls for
a taxpayer bailout of insurance companies. Paul was the lone Republican senator to vote against the budget resolution to repeal the ACA.
“If Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of Obamacare,”
Paul wrote. “For mark my words, Obamacare will continue to unravel and wreak havoc for years to come.”