Within hours of taking the oath of office, President Trump took steps to continue the GOP’s pledge to repeal the Affordable Care Act. His Republican counterparts on Capitol Hill, however, missed their first self-imposed deadline on passing legislation to do so.
President Trump signed an executive order calling for “minimizing the economic burden” of the Affordable Care Act. According to Politico, federal agencies could use the order to stop enforcing the individual mandate, but many don’t believe the Administration will take such measures in the immediate future for fear it will undermine the insurance market before GOP plans for a repeal and replacement are worked out.

Thanks to pressure from advocates, more and more Republicans are now saying that a replacement health plan should be offered at the same time as repeal legislation, or that multiple bills to replace parts of the ACA could be moved on a piecemeal basis. This may be one reason why the four committees that have jurisdiction over health policy – two in the House and two in the Senate – missed the Jan. 27 deadline to draft portions of a repeal bill. The Jan. 27 deadline was put in place by the budget resolution Congress passed in mid-January but was nonbinding.

Once drafted, these portions will then likely be combined into a final piece known as a reconciliation bill, which would also only need a simple majority to pass the Senate (for more information on reconciliation, see this blog from the Center on Budget and Policy Priorities). If Congress goes with a reconciliation bill, it’s widely expected that it would eliminate the billions of dollars provided to the states that have chosen to expand Medicaid eligibility, and repeal the subsidies that help lower-income individuals afford insurance through the exchanges.

Congress is under pressure by insurers to settle on repeal and replace legislation by March or April, and there have been plans by the relevant committees to complete their work by late February in order to meet this deadline. They would like Rep. Tom Price (R-GA) to be confirmed as Secretary of the Department of Health and Human Services in order to develop the replacement plan; his confirmation vote may take place as early as this week. However, President Trump said on Feb. 5 that the repealing and replacing the ACA could take until next year, underscoring the uncertainty of the timing.

The specifics of what a replacement plan may look like have not yet been released, though CQ reported that it is likely to do away with all or most of the taxes that finance the law, similar to the GOP’s attempt to repeal the ACA in 2015. Two alternative replacement plans were introduced by Senate Republicans, one by Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) and one by Sen. Rand Paul (R-KY); neither are expected to move forward, but they may influence the final replacement plan. According to the Center on Budget and Policy Priorities, the Cassidy-Collins bill “would likely leave many millions who now rely on ACA health coverage, especially those with low incomes and pre-existing health conditions, uninsured or going without needed care.” CBPP also put together a “False Promises Primer” matrix that lists what the various GOP health proposals do, what they’ll say, and how they differ from and fall short of the ACA. The Hill reported that the House Energy and Commerce Committee is considering a measure that would prohibit insurance companies from denying coverage to those with pre-existing conditions but would not limit what insurers can charge, and another measure that would increase how much older people could be charged compared to younger people.

Advocates contend that Members of Congress who vote to repeal the ACA with no plan in place to assure continued coverage, or a plan that reduces benefits or increases costs, are willing to put millions of people’s health and lives in peril. If all Democrats and Independents remain unified, the defection of three Republican Senators would defeat specific ACA replacement plans. For more information on the FY 2017 budget resolution that set repeal efforts in motion, see the Jan. 17 Human Needs Report.

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