"Repeal and Replace" - Real or Not?
May 10th, 2017
On May 4th, 2017, the House of Representatives passed H.R. 1628, the American Health Care Act of 2017 (AHCA), which was this administration’s attempt to repeal and replace the Patient Protection and Affordable Care Act (Obamacare). While it did not happen as fast as the President and Congress wanted, it did fulfill a promise that they had made to the American people. The question is, did the repeal and replace really repeal and replace Obamacare? As with all things Government the answer is kind-a yes and kind-a no.
First, no matter how good the AHCA is, it still is far from law. The bill has now gone over to the Senate where one of three things could happen, the Senate could:
- Vote on it without making any changes, it does not pass and dies in the Senate. This will not happen since the Majority leader has already said they were going to make changes and would not bring it to the floor if he did not have the votes to pass it.
- Vote on it without making any changes and it passes. This will not happen because any health care bill would need virtually every Senate Republican vote in order to pass and there are already many Republican Senators who have said the House bill has measures they could not vote in to law.
- Make changes to the bill and send it back to the House and the House and the Senate would then get together in a conference to craft a bill that both chambers could live with. This is the most likely scenario but there is no guarantee how long the Senate will take to make changes and, the bigger question is, can the Senate and the House come up with a bill that will get enough votes in both chambers to pass it.
What we need to remember is that while all this is going on Obamacare is still the law of the land and until the President signs a new law, premiums will continue to climb, access to care will continue to be reduced and Medicare provider payments will continue to be cut.
In deciphering the House bill and statements made by members of the Senate and the President, there are some general observations we can make about what a Republican health care bill would look like:
- It will retain some parts of Obamacare, like the measures that allow young people to stay on their parent’s insurance until they are 26 and the ability to get affordable insurance even with pre-existing conditions. This last benefit has caused quite a stir since the House bill gave the States more power on how to handle people with pre-existing conditions. This benefit is the one that the Senate will most likely change in some manner.
- Many of the taxes, payment cuts and regulations will be removed but there is still a lot of discussion on which ones might be retained.
- It will no longer require people to purchase health insurance and pay a fine if they don’t. Instead, it will encourage people not to have breaks in their insurance coverage which would allow insurance companies to charge them more.
- It puts a cap on state Medicaid spending by states and pushes more of the decision making and power to the states, allowing them to apply for waivers and to have more say in how health care is administered in their state.
- It reduces the number of people that qualified for subsidies, saving money since 85% of the people that signed on to Obamacare received some sort of Government subsidy.
- It has the chance to raise the insurance premiums for the 50 to 64-year-olds. This provision is another piece of the bill that will have the attention of the Senate.
- Insurance companies would have more flexibility on the type of plans they offer.
As you might imagine there are many more details, all of which could be changed as the Senate begins their work on the bill. There are two things that RetireSafe will be watching closely, whether all the cuts to Medicare are restored and whether the 50 to 64-year-olds are offered a transition period so the rug is not pulled out from under them. We think these are two important areas that we have spoken out about and will continue to do so.
As you can see, so far, there was not a full repeal and the replacement still has some Obamacare characteristics. What is sure is we are on the way to turning away from the destructive pathway that Obamacare was taking us down. It’s up to the House and the Senate to see if they can craft something that will lead us to health care that is reasonable and sustainable.
We will keep you informed as the AHCA comes closer to real law.