GOP hopes bud­get will lead to re­plac­ing ACA

Modern Healthcare - - NEWS - By Paul Demko

WASH­ING­TON—With their late-night vote last week, Se­nate Repub­li­cans have joined their House coun­ter­parts in pass­ing bud­get blue­prints that set the stage for a fierce battle with the White House over the shape of the na­tion’s health­care sys­tem and ap­pro­pri­ate lev­els of tax­a­tion and spend­ing.

The Repub­li­can plans to re­peal the Af­ford­able Care Act, sig­nif­i­cantly change health­care pro­grams and bal­ance the bud­get within a decade con­trast sharply with the vi­sion laid out by Pres­i­dent Barack Obama. But key dif­fer­ences also re­main, par­tic­u­larly on Medi­care, be­tween the House and Se­nate plans.

Repub­li­cans now need to fill in the de­tails—and large fi­nanc­ing gaps—of their bud­get res­o­lu­tions and try to reach an agree­ment be­tween the two cham­bers. Ap­pro­pri­a­tion com­mit­tees will begin that process when they re­turn to Wash­ing­ton in mid-April.

The Se­nate blue­print, in par­tic­u­lar, leaves a lot of de­tails un­spec­i­fied. Robert Green­stein, pres­i­dent of the left­lean­ing Cen­ter on Bud­get and Pol­icy Pri­or­i­ties, said there’s a “magic as­ter­isk” in the GOP plans that elim­i­nates about $1 tril­lion in rev­enue from the ACA with­out pro­vid­ing any re­place­ment fund­ing or cor­re­spond­ing cuts.

House and Se­nate Repub­li­cans will have to square their dif­fer­ences over Medi­care be­fore pass­ing a fi­nal bud­get. The House calls for trans­form­ing the pro­gram into a de­fined-con­tri­bu­tion model, which Repub­li­cans call pre­mium sup­port. That change would take ef­fect start­ing in 2024. Se­nate Repub­li­cans, some of whom are eye­ing pres­i­den­tial runs, have taken a less ex­plicit ap­proach to the popular se­nior pro­gram. Their plan calls for the same level of Medi­care spend­ing cuts—$400 bil­lion over 10 years—that were in­cluded in the pres­i­dent’s bud­get. But they of­fered no de­tails on how to achieve those sav­ings.

The House blue­print pro­poses turn­ing Med­i­caid into a capped state block­grant pro­gram and slash­ing fed­eral spend­ing by nearly $1 tril­lion over 10 years. The Se­nate was less ex­plicit, although it’s ex­pected Repub­li­cans there will em­brace the House ap­proach.

If Repub­li­cans in the two cham­bers can agree on a bud­get, they could use the so-called bud­get rec­on­cil­i­a­tion process to avoid a Se­nate Demo­cratic fil­i­buster and pass leg­is­la­tion to re­peal and re­place the ACA if the U.S. Supreme Court in June strikes down pre­mium sub­si­dies in roughly two-thirds of the states. They hope that leg­is­la­tion would form the ba­sis of ne­go­ti­a­tions with the White House on re­vamp­ing the health­care re­form law.

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