An­other bat­tle over ACA re­peal and re­place looms

Modern Healthcare - - THE WEEK AHEAD - —Vir­gil Dick­son

When Congress re­turns from break, re­peal­ing and re­plac­ing the Af­ford­able Care Act will again be at the top of Repub­li­cans’ to-do list. But it re­mains un­clear if the House is any more likely to pass a bill this time around.

Pres­i­dent Don­ald Trump be­lieves that he can’t pass big, per­ma­nent tax cuts un­til the ACA’s spend­ing and taxes are cut way back. “Health­care is go­ing to hap­pen at some point,” Trump said last week. “But the tax re­form and the tax cuts are bet­ter if I can do health­care first.”

The ACA re­peal-and-re­place bill would erase nearly $1 tril­lion in taxes and $1 tril­lion in spend­ing, which would help Repub­li­cans en­act per­ma­nent tax cuts through budget rec­on­cil­i­a­tion leg­is­la­tion. Such leg­is­la­tion can be passed on a straight party-line vote. To use rec­on­cil­i­a­tion, though, the tax bill could not in­crease the budget deficit af­ter 10 years, un­der Se­nate rules.

But health­care leg­is­la­tion re­mains an up­hill bat­tle. The ul­tra­con­ser­va­tive House Free­dom Cau­cus wants to gut the ACA’s in­sur­ance reg­u­la­tions re­quir­ing min­i­mum essential ben­e­fits and mod­i­fied com­mu­nity rat­ing, al­low­ing in­sur­ers to charge older peo­ple and those with pre-ex­ist­ing con­di­tions higher rates.

More mod­er­ate House and Se­nate Repub­li­cans are leery about those changes, as well as the pro­jec­tion that the bill would spike pre­mi­ums in 2018 and 2019 and lead to 24 mil­lion fewer in­sured peo­ple. Democrats strongly op­pose the leg­is­la­tion.

Repub­li­cans would have to move fast. They have to pass a bill to fund the govern­ment by the end of this month. If they can’t agree on a health­care bill to fold into the budget rec­on­cil­i­a­tion, they won’t get an­other shot at rec­on­cil­i­a­tion un­til late sum­mer or fall, when they also want to en­act tax re­form.

In ad­di­tion, Trump and Congress need to pro­vide cer­tainty for in­sur­ers, which have un­til June to de­cide whether to of­fer in­di­vid­ual-mar­ket plans and how much to charge.

Trump

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