With midterm elections looming and many experts predicting a Democratic sweep, Republicans may be considering another attempt to repeal the Affordable Care Act (ACA). This would be the fourth attempt by the GOP to repeal the national healthcare act, something many Republican candidates promised constituents during the 2016 campaign season. Although there is little indication that any attempts to appeal the ACA have improved over the past year, there are reports that a project that has been in process for over a year could result in a new healthcare policy that will gain the support of the people as well as majority support in Congress.
Senate Project
Galen Institute President Grace-Marie Turner recently stated that Republicans have never given up on repealing and replacing the ACA. She pointed to the fact that Republicans had eliminated subsidies to insurance companies as an indication they were still working on changing the healthcare bill. Turner also said that the GOP had been working “every week since October to refine the legislation at the behest of the Senate.” According to Turner, groups including the Heritage Foundation, Ethics and Public Policy Center, and the American Enterprise Institute, along with think tanks and experts around the country, have been creating a proposal that would address the shortcomings of the ACA without eliminating coverage.
Law Changes
Republicans have taken several bold steps in recent months to undermine Obamacare. By Executive Order, President Donald Trump allowed government agencies to waive, defer or grant exemptions for any provision of the ACA that could cause a financial burden. The IRS stopped rejecting returns that did not indicate whether a taxpayer had health insurance, and the period to sign up for policies was shortened significantly during the most recent enrollment season. Finally, the Trump administration eliminated cost-sharing reduction payments to insurers, which help to reimburse carriers for reducing cost-sharing amounts to lower-income enrollees. And Congress, as part of their tax cut bill passed in December, eliminated the individual mandate requirement starting in 2019.
Heritage Foundation Proposal
In April, an open letter to the American people appeared on the Heritage Foundation website. The letter, written by Turner and Marie Fishpaw, Director of Domestic Policy Studies for the Foundation, and signed by over 30 conservative leaders, stated that the Foundation, along with Senator Lindsay Graham, Senator Bill Cassidy, Senator Ron Johnson and Senator Dean Heller, had been working on a plan that would address increased health costs and reduced healthcare options.
According to the letter, a plan that works in Massachusetts would not be suitable in Mississippi. There also needs to be different plans that address the needs of urban vs. rural Americans. Instead of money flowing from the government to insurance companies, funding would be provided to the states, which could then develop their own healthcare plans based on the needs of their constituents. Developed over the course of a year, this particular plan was created using suggestions from consumers, patients, doctors and state legislators rather than by Congressional lawmakers alone. Former Senator Rick Santorum noted that this action was the first he had seen that was developed “from the bottom up and the inside out.”
State Control
States have lost overarching control over their individual healthcare programs, including Medicaid, which poses a challenge to healthcare reforms going forward. One of the changes made by the Trump administration is a push for the Centers for Medicare and Medicaid (CMS) to allow waivers to any state that wants to implement changes to its Medicaid programs. This includes requiring small co-payments and work requirements. A transfer of control to the state may be included in any attempts by the GOP to repeal and replace the ACA. In fact, the letter issued by the Heritage Foundation indicates that this is exactly what the GOP plans to do. It is possible that the plan created by the conservative think tanks will include block grants to states, which would allow them to develop their own healthcare programs.
For their parts, Democrats are highlighting the failed attempts by Republicans to repeal and replace the ACA in their campaign advertisements. Many are pledging to fix the problems with the current healthcare bill rather than “sabotaging” the law as Republicans have attempted to do over the past two years. Instead of claiming that the ACA is working, Democrats are now admitting that the law is flawed and vowing to fix the things that need fixing without eliminating healthcare for millions of people. With midterm election several months away, insiders claim that the GOP has not given up on repealing and replacing the ACA before November. Without ACA reform, experts believe that Democrats will definitely take control of the House and, although it may be more difficult, could also take control of the Senate.
