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Episode 1 – Obamacare Repeal and Replace

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Unlocking the Puzzle of the Obamacare Repeal and Replace Plan

As I said when introducing the American Health Care Act (aka Obamacare repeal and replacement), my first introduction to that bill was a host of punctuation directives after the introductory sentence. Many people are calling this Obamacare Lite, and when I read the first paragraph, I am forced to agree. Why?

The first paragraph reads as follows:

“Subsection (b) of Section 4002 of the Patient Protection and Affordable Care Act (42 U.S.C. 300u-11), as amended (emphasis mine) by Section 5009 of the 21st Century Cures Act is amended (emphasis mine AGAIN)–”

What Do I Think?

Let’s just stop here for a moment and take in the beginning paragraph of what is supposed to be the repeal and replacement of the Affordable (better known as Unaffordable) Care Act. However, the very first sentence uses the word “amended” TWICE as the first legislative action in the repeal and replacement action by our Republican majority Congress.

This first sentence appears to be more of a patchwork between two laws – the ACA and the 21st Century Cures Act, and not any basic repeal – just an amendment (at least in my eyes).

I wanted to find out what the 21st Century Cures Act is all about. I have heard about it, but I until I just looked it up, I didn’t know much about it. So this was a learning experience for me as well as you, my readers. First of all, it is a bill originating out of the House of Representatives 2015-2016 session, according to the website CONGRESS.GOV, and it has only passed the House, not the Senate so it is not yet law. How handy to have an old bill that has not completely passed Congress yet, or signed into law, to patchwork into the Obamacare repeal and replace bill. Maybe this is their idea of government efficiency.

TheĀ  basic summary of the 21st Century Cures Act is, according to CONGRESS.GOV is this:

“The NIH [National Institute of Health] and Cures Innovation Fund is established and funds are appropriated: 1) for biomedical research including high risk, high reward research and research conducted by early stage investigators; 2) to develop and implement a strategic plan for biomedical research; and 3) to carry out specified provisions of this Act.”

In short, Congress proposes to appropriate some taxpayer money (everything the government has belongs to “we the people,” you know) to fund biomedical research.

It is also interesting to note in the 21st Century Cures Act I am looking at, the section numbers only go as far as 4061, so the Section 5009 referred to in the first sentence of the repeal and replace plan for Obamacare must be brand new.

Then the American Health Care bill goes on to add a series of conjunctions and punctuation directions as well as striking the phrase “each of fiscal years 2018 and 2019,” and inserting “fiscal year 2018.” Then about four paragraphs are stricken to be replaced with the following sentence and a few others after it, but for today, I am only going to focus on this one substituted sentence.

“(b) Rescission of Unobligated Funds. – Of the funds made available by such section 4002, the unobligated balance at the end of fiscal year 2018 is rescinded.”

I suppose that means that if Congress has not committed a certain amount in funds to any particular recipient by the end of that year, that amount cannot be paid out. Does that amount then go back into the federal government’s general fund?

The next question is – Where are funds being directed as a result of Section 4002 of the ACA? According to a fact sheet by the American Public Health Association, Section 4002 covers the Prevention and Public Health Fund. So the logical deduction for this first tidbit from the Obamacare repeal and reform bill is that if there are any public health funds that go unclaimed by the government’s Prevention and Public Health Fund at the end of fiscal year 2018, they will NOT be used by that fund at all.

It is interesting to note that, according to a chart on the APHA fact sheet, the amount that remains appropriated for the Prevention and Public Health Fund as of 2015 (after one cut in 2012 and a sequestration cut in fiscal year 2015, is $927 million. Who knows how much of that will remain unobligated by the end of fiscal year 2018? It’s possible this first section could be interpreted as a repeal provision of the ACA. We’ll see.

Stay Tuned for More

Whew! That was something else! I don’t suppose there is a translation somewhere for the “average Joe,” so I will continue to do my best to analyze this Obamacare repeal and replacement bill as it is worded in the text I have, and as my poor little brain can handle.

Sources for further reading:

http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/documents/AmericanHealthCareAct.pdf?platform=hootsuite

https://www.congress.gov/bill/114th-congress/house-bill/6

https://www.apha.org/~/media/files/pdf/topics/aca/2015_pphf_fact_sheet.ashx

 

Author:Cathy Wentz

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