Congress is moving ahead with a plan to repeal core elements of the Affordable Care Act (ACA), but some lawmakers are beginning to have second thoughts about how far they should go.
Relying on a fast-track procedure called budget reconciliation, four congressional committees have been tasked with coming up with detailed repeal legislation, with a vote likely to come sometime in March. But that timeline could slip because many lawmakers have already begun to hear from constituents concerned about what repeal might do to their own healthcare. Other lawmakers are worried repeal could cause chaos in the insurance market, or that constituents could lose coverage altogether.
For some, the change in heart came with the release of a new report from the nonpartisan Congressional Budget Office concluding that ACA repeal would result in an estimated 18 million people losing health insurance in 2018, rising to 32 million by 2026. The report also stated that repeal would likely result in a 20 – 25 percent hike in health insurance premiums over the next year.
As a result, some top lawmakers are shifting their sights from repealing and replacing ACA to the more modest goal of repairing it so as to avoid negative repercussions—to their constituents and their political careers.
Perhaps the deepest split among Republicans is over what to do about the ACA’s Medicaid expansion, which extended coverage to about 11 million new low-income people. Legislators from the 31 states that accepted the expansion are more likely to want to preserve that expansion and the federal funds that came with it. (http://thehill.com/policy/healthcare/315173-gop-governors-defend-medicaid-expansion)
Also at issue is what to do about the taxes assessed by the ACA, like the so-called Cadillac tax on employer-based health plans and the medical device tax. While some GOP lawmakers insist those tax provisions must go, others say the revenue is needed to help pay for any replacement plan.
We will continue to monitor this issue and will report back to the membership in future issues of SGIM Health Policy News.