ACA Replacement Bill Shows Signs of Life

Republicans and Democrats square off over repealing the Affordable Care Act

By Stephen Miller, CEBS Apr 28, 2017

​House Speaker Paul Ryan

Update: House Passes Republicans' ACA Replacement Bill

The U.S. House of Representatives passed the American Health Care Act on May 4, 2017. For full coverage of the bill and what comes next, see House Passes GOP Health Care Bill; Now What?

updated on May 3, 2017

Republican's efforts to repeal and replace the Affordable Care Act (ACA) are back from the dead, though not yet out of intensive care.

Negotiations between the party's conservatives and moderates are continuing, as GOP leaders seek enough votes in the House to pass a revised version of their replacement bill, the American Health Care Act (AHCA). On May 3, House Republicans corralled a few more votes among moderate GOP lawmakers after promising an additional $8 billion over five years to help those with pre-existing conditions pay for health care in the individual insurance market.

A House vote on the measure was scheduled for May 4.

Democratic congressional leaders still hope for the bill's demise in the Senate, after which some see bipartisan opportunities to fix the ACA's problems and address rising health care prices.

GOP Leaders Seek Votes

"What we're trying to do is find where that consensus lies," said House Speaker Paul Ryan, R-Wis., who along with congressional bigwigs from both parties participated in moderated discussions at law firm BakerHostetler's 2017 Legislative Seminar, held April 26 in Washington, D.C. "Getting consensus among our members [in Congress] is always a challenge, especially when you're trying to do something as enormous as repealing and replacing Obamacare. We're making progress, but it takes time."

"Republicans are under pressure to repeal, replace [and] get something done," added House Majority Leader Kevin McCarthy, R-Calif. "We're going to get [the AHCA] up and out," he said optimistically, after which it would be the Senate's turn to try to find majority consensus among GOP senators.

"It doesn't matter if 90 percent of your members [in Congress] are for you, if 90 percent is neither 51 votes in the Senate or 218 votes in the House, " said Sen. Roy Blunt, R-Mo., vice chairman of the Senate Republican Conference. "You may be able to coalesce a majority of Republicans around [a bill], but it's harder to coalesce a majority of the Congress if it takes all Republicans [in the House and Senate] to do that."

Blunt said to expect Health and Human Services (HHS) Secretary Tom Price to provide relief from ACA compliance requirements through regulatory reform, to the extent that this is allowed by the statute itself. "There are 1,440 places in the ACA that say some government agency, normally HHS, will further define what this means," he noted.

Limited relief for employers from some of the ACA's administrative burdens could be provided through regulatory means, because "there is no better place to get health insurance than through work," Blunt said, and Washington should support, not impede, employer-provided health care.

Added Rep. Steve Scalise, R-La., House Republican Whip and the third-highest ranking member of the House leadership, small businesses in particular face "disincentives to hiring right now because of Obamacare. Because if you're at 48 employees, you don't want to go over the 50-employee threshold" that triggers requirements to provide full-time employees with ACA-compliant coverage. The law's provisions also are driving some employers to move employees to part-time status to avoid the coverage requirement, "or keep them part-time even if you want them to be full time."

Scalise also pointed to shared premium increases in the small-group market, saying, "If you're trying to figure out how to balance your own company's budget and you're getting a 25 percent increase in your health care premium, it's really crushing."

Ryan noted that "there are other things we think are necessary to do with health care" and pointed to the House's passage last month of the Small Business Health Fairness Act, which permits wider use of association health plans. These plans would "let a farmer buy health insurance through the national American Farm Bureau plan, so she can harness the buying power of all American farmers instead of just her family's. Things like that you cannot put in a budget bill"—because a bill with that stipulation would likely face a Democratic filibuster in the Senate—"but we think they are really important to help people get affordable coverage."

[SHRM members-only toolkit: Managing Health Care Costs]

Democrats See It Differently

"I've seen the partisanship escalate very substantially in the 36 years I've been in Congress," said House Democratic Whip Steny Hoyer, D-M.D. his party's No. 2 leader in the House. "Technology has allowed us to discretely identify voters much more efficiently and effectively so that you can divide the country on a very partisan basis," he remarked. Not coincidentally, "the media has become more confrontational; whether its Fox or MSNBC, it's not Walter Cronkite." Congress "is a representative body and reflects that polarization to the detriment of the country," but "you cannot solve America's problems in 24-month cycles," thinking about the next House election, he noted. "We need to think longer-term."

Concluded Hoyer, "Hopefully, as time goes by, we will see opportunities to work together for the good of the country."

"Let's fix the problems," added Sen. Tammy Baldwin, D-Wis., who played a leading role in passing the ACA. "Democrats are ready to help improve the health care system, but the Republicans' bill would lead to 24 million more uninsured Americans by 2026," she said, referencing an analysis by the Congressional Budget Office. (Republicans dispute this finding). Increasing the number of uninsured Americans is unacceptable to Democrats, Baldwin noted, and the parties can't work together on health care "as long as this is about repeal of ACA."

But countering the high cost of prescription drugs is an issue where the parties might be able to come together, she added. "Having Medicare negotiate for better prices is an area for bipartisan support," and President Donald Trump has expressed interest in this reform, she said.

"If the president pushes on it," controlling prescription drug prices is "something that could get done," agreed Rep. Anna Eshoo, D-Calif.

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