Obamacare Lives -- For Now Anyway
The Swine Line is the staff blog of Citizens Against Government Waste (CAGW) and the Council for Citizens Against Government Waste (CCAGW). For questions, contact email@example.com.
Today certainly was a disappointing day for congressional Republicans. Since March 23, 2010, seven years ago yesterday, Republicans have wanted to repeal and replace the Patient Protection and Affordable Care Act, better known as Obamacare. But, House Republican leadership was unable to satisfy enough members in their caucus to vote for their repeal and replacement bill, H.R. 1628, the American Health Care Act.
Some members wanted complete repeal of Obamacare, others felt complete repeal was not possible through budget reconcilation, the process Republicans were using to repeal the healthcare reform law and replace it.
The reconciliation budget process, which is described here, only takes a simple majority in the Senate, thus it avoids the sixty votes needed to overcome a filibuster. Since Republicans only have 52 votes and knew Democrats were unlikely to vote for a bill that begins to unravel their healthcare law, reconcilation seemed like a good tactic. But reconciliation only deals with taxing, spending and the debt limit so the legislation must be crafted carefully. For example, to nullify the individual mandate to purchase insurance, the bill reduced the fine for not purchasing insurance to $0.00.
Citizens Against Government Waste (CAGW) supported the bill because it accomplished quite a bit of important healthcare policy that Republicans had sought for years. For example, it repealed the individual and the employer mandates, provided advancable, refundable tax credits to help people purchase insurance in the individual market, increased the contribution limits to Health Savings Accounts and expanded their flexibility. It ended the taxes on medical devices, pharmaceuticals, and health insurance. These taxes helped to drive up costs and were passed onto consumers.
H.R. 1628 provided substantial reforms to Medicaid, stopped the costly expansion of the program that is fast consuming state budgets, and gave the governors and state legislatures the power to manage the program by providing either a block grant or per-capita cap funding mechanism. It put the entitlement program on a budget for the first time.
CAGW's sister advocacy organization, the Council for Citizens Against Government Waste, wrote a letter of support for the legislation.
Republicans planned to institute other changes through the administrative process. In fact, Health and Human Services Secretary Tom Price had begun that phase of repealing and replacing Obamacare already.
So what now? Certainly, Republicans are re-evaluating their options. There is always a possiblity the House may make a few tweaks and consider another vote. Or, perhaps the Freedom Caucus, a group of the most conservative members in the House, which opposed H.R.1628 in great numbers, will produce a plan that can gather the votes needed to pass a bill and survive the reconcilation process. Or perhaps the Republicans can convince at least 8 Senate Democrats to support their measure and repeal all of Obamacare through the regular legislative process.
But one thing is clear, President Trump, who also expressed his disappointment over the failure to pass a bill, is correct. Obamacare will implode. It is failing now. On February 15, Aetna CEO Mark Bertolini declared Obamacare is in a death spiral and other insurers are considering withdrawing from the marketplaces in 2018. In addition, more than 1,000 counties, almost one-third in the U.S., have only one health insurer on the Obamacare exchange. Premium rates sky-rocketed for 2017 and they are expected to be much worse next year.
Perhaps in the fall of this year, when the new Obamacare premium rates are approved and people who purchase insurance in the individual market see their rates, there will be the momentum to try again. Only time will tell.