Repealing ACA… but What About the Replace?

With the Congressional transition now complete, true to their word, Republican leadership is taking up the repeal of the Affordable Care Act as their initial agenda item. And the first hurdle has been cleared in a 51-48 Senate vote with Rand Paul the only senator to break ranks. Political jockeying is filling the airwaves with Mike Pence citing the failure of “Obama”care (Pence’s emphasis added) to control rate increases and also highlighting the cost-sharing in those plans which is unaffordable for most Americans. The Democrats are emphasizing the success of ACA, pointing out that 8.8 million have enrolled as compared with 8.6 million last year. They are washing their hands of any responsibility for healthcare now that the power has shifted. The Democrats are also posturing to slow down votes on cabinet nominations. One of their targets is Tom Price as HHS Secretary. Price has been an active, consistent opponent of ACA and has led the repeal effort since ACA became law.

Since repeal seems fairly certain, the question turns to replace with what? We have heard sound bites on HSAs and tax deductions rather than individual mandates. We have also heard that Medicaid block grants are part of the replace strategy and even Paul Ryan asserting that the Republicans may be ready to take on Medicare cuts next. I view all of these as trial balloons with nothing firm.

My sense is that this is going to be a bloody street fight. I don’t feel that President-elect Trump is going to look for consensus and the Democrats are not going to roll over. President Obama is urging that they rally to save whatever they can. And the 30 million who have recently acquired coverage are being placed on a treacherous roller coaster ride. This is going to be fascinating to watch.

I write weekly about healthcare in America and employee benefits in Frenkel Benefits' blog. If you're looking for more insight about post-election healthcare, subscribe to receive our weekly blog posts.