With the election of Donald Trump, Republican congressional leaders are eagerly formulating their strategy for repealing the Affordable Care Act. Under their latest plan, “repeal and replace,” Republican leaders would quickly hold a vote to repeal the ACA, or at least portions of it, but set the effective date of the repeal for sometime in the future to give themselves time to come up with a replacement.
This is not workable.
The House has voted more than 60 times to repeal the health insurance law that was a cornerstone of the Obama administration. However, it was easy to vote for a repeal when they knew it had no chance of becoming a reality because President Barack Obama would veto such legislation.
With that brake in the White House soon to be gone, a repeal vote could actually have consequences, such as depriving 20 million people of health care. That alone should give lawmakers pause in their rush to keep a campaign promise.
Realizing this, Republicans have been soft pedaling their approach to the ACA. A plan under consideration would involve lawmakers repealing Obamacare soon after they return to Washington in January. They can do this with only 51 votes — and, therefore, no participation from Democrats — in the Senate through the budget reconciliation process.
Republicans wouldn’t have a replacement ready for votes for perhaps three years, so the ACA wouldn’t actually be repealed until then. A further complication is that a replacement would have to go through the typical Senate process, where Democrats could filibuster options they do not like.
Under their “repeal and replace” scenario, Republican leaders pretend that somehow people covered by the ACA will continue to have health insurance until they have a replacement figured out, even if it takes years.
But this isn’t how it would work.
Once they knew the ACA was headed for repeal or significant change, with no idea of what would replace it, insurance companies would have no incentive to continue to develop new policies or to bring new customers into the system build around the 2010 law. That system would slowly collapse, well before the GOP has developed a replacement.
“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University, told The New York Times. “Insurers need to know the rules of the road in order to develop plans and set premiums.”
Lawmakers also can’t repeal just the unpopular parts of the law, especially the individual mandate, and pretend the system will continue to work. The individual mandate was meant to bring younger, healthier people in the ACA market. Without them, the ACA pool is older and less healthy — and more expensive to insure.
U.S. Sens. Susan Collins and Angus King will be important bulwarks against this wrong-headed approach. King is opposed to repealing the ACA but open to changing parts of the law, if people currently covered do not lose their insurance.
“In addition to the direct human costs, the idea being floated of ‘repeal now, replace later’ injects a high level of uncertainty into the entire health care system, which currently constitutes one-sixth of our national economy. This is as dangerous as it is unnecessary,” King said in a statement to the Bangor Daily News.
“Those so intent on repealing the law have had seven years to come up with a credible replacement but have never done so,” he added. “My position is simple: Let’s see the replace before we start talking about the repeal.”
Collins has long advocated changes to the ACA but she believes a replacement plan must accompany any repeal effort to prevent people, including 84,000 in Maine, from losing their insurance coverage. As for fixes, Collins would target the rapid rise in premium costs and the decrease in insurers participating in the ACA marketplaces in many states, including Maine.
“We have an opportunity to develop solutions that are affordable and ensure that Americans have access to diverse insurance plans that meet their needs,” she said in a statement to the BDN. “I look forward to evaluating all legislative reform proposals introduced in the new Congress to increase the availability of affordable, quality healthcare for millions of Americans.”
The best way for Congress to proceed is to develop workable fixes to the ACA instead of voting to repeal it.