The past week or so has certainly been a roller coaster ride, with ups and downs and twists and turns, when it comes to the fate of the effort to repeal and replace the Patient Protection and Affordable Care Act (otherwise known as Obamacare). In the build-up to a possible full House of Representatives vote on the American Health Care Act (to replace Obamacare), the talk was thick and fast about the possibility of the bill passing. President Donald Trump had launched an all-out hard sell push while Speaker of the House Paul Ryan worked over his Republican colleagues in the House.
When the push came to shove though, Ryan was forced to admit Friday that he did not have enough votes in the House to pass the bill, even after extending the “deadline” for bringing the health care bill to the floor for a vote from Thursday to Friday.
What Brought the Repeal and Replacement Effort to Such an Abrupt Halt?
The bill had been hanging by a thread as members of the Freedom Caucus, a group of very committed conservatives, voiced their objection to the bill because it did not go far enough in addressing and correcting the problems caused by Obamacare. Upon reading an analysis of the bill by Jeffrey Singer, a surgeon writing on behalf of the Cato Institute (1), the bill clearly did not fully roll back many of the mandates that are making Obamacare incredibly expensive.
Dr. Singer wrote that the American Health Care Act proposed to remove the individual mandate for all U.S. citizens to buy health insurance, well – more or less. Instead of the individual mandate that would result in a penalty “tax” paid to the federal government for those who choose to go without health coverage during the year, the new bill would impose a 30 percent premium surcharge effective for one full year on anyone who goes without continuous insurance coverage for more than 63 days in a year and then gets insured.
“… Sounds a lot like a Republican version of an individual mandate,” Dr. Singer commented, noting that the ACA makes the individual penalty for going without insurance payable to the Internal Revenue Service while the premium surcharge for the skipping insurance for a while under the Republican plan would go directly to insurance companies. Hmmmm.
As the repeal and replacement bill moved through committee scrutiny, according to an article by Kimberly Leonard with U.S. News and World Report, “Republicans Make Changes to Health Care Bill” (2), it underwent some changes with the apparent purpose of keeping many factions in Congress happy. One of those changes was dubbed a “manager’s amendment” that appeared to be in response to “findings” (from whom; from where?) that one group of people that would take a hit with coverage challenges, such as higher premiums, would be older people who were not yet eligible for Medicare. This change was placed in the bill to instruct the Senate to add a provision that would set aside a $75 billion reserve fund to deal with that issue. However, this “manager’s amendment” did not appear to stipulate how that reserve fund would be used.
This article also reported a couple of changes made to make staunch conservatives happy, which included the following:
- The repeal of taxes connected to the ACA one year earlier than planned in the original bill
- Alterations to Medicaid that would give states the freedom to implement work requirements for some Medicaid beneficiaries and would give states a choice in terms of how they received funding for the program from the federal government.
Then there were provisions in the bill that were left unchanged despite efforts by the more conservative Republicans to jettison them. They were:
- Keeping the provision allowing insurance companies to penalize people who allowed their coverage to lapse more than 63 days at time with a 30 percent surcharge on their premiums.
- Phasing out Medicaid expansion two years earlier than planned in states that had accepted Medicaid expansion.
Another point of contention between conservatives and the more centrist members of the Republican party, not to mention most of the Democrats, was that of essential benefits mandated to be included in the ACA-compliant plans. Such benefits included maternity care, mental health, prescription drugs, and several preventive care services that would not require out-of-pocket costs for patients. The logic of eliminating these mandates was that insurance premiums could decrease because insurers would not be required to pay for all those bells and whistles. Then consumers could choose plans with or without those benefits, depending on their personal needs or preferences.
According to an article in The Hill entitled “What the GOP’s plan to kill essential health benefits means” by Peter Sullivan (3), an aide to Senate Minority Leader Charles Schumer said that it would mostly likely not be permissible to repeal those essential health benefits in a Senate reconciliation bill, and a regular bill with that provision would be highly unlikely to command the 60-vote threshold needed to pass it.
Another Issue for Another Day
The issue of essential health benefits is very complex and requires much more discussion than I can give it at the end of today’s post, so I plan to give it some detailed and considerate attention in my next post.
Hope Remains for the Future
I was gratified to learn Monday that neither congressional Republicans nor President Trump are going to abandon the project of repealing and replacing Obamacare, but will return to the issue again (although they did not say exactly how soon). I retain hope that Congress can work something out that will benefit all Americans one way or another and that someone in leadership can tell us more about it than “it will be great.” I am personally committed to helping educate our leaders with the real reason Obamacare is failing and some real solutions because I do not feel that Congress or the White House has dug deep enough into the real cost drivers for medical care.
Sources for further reading: