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July 5, 2017

If Lawmakers Had Stuck to Original ACA 'Repeal,' Bill Would be Law, Market Observers Say

IPI expert referenced: Merrill Matthews | In The News | Media Hit
  Best Wire

By Frank Klimko

If Republican lawmakers had stuck to their first strategy of immediately repealing the Affordable Care Act without worrying about a replacement that bill would probably be law by now, said Institute for Policy Innovation resident scholar Merrill Matthews.

"Had Republicans gone with their original plan, they would have repealed Obamacare when it was at its height of unpopularity. The public would have cheered," Matthews said in a statement. "The best strategy was to pass the repeal legislation."

"It's not clear that a stand-alone repeal vote will have enough Republican votes to pass now," Matthews said.

Matthews noted Sen. Rand Paul, R-Ky., has now endorsed the idea of a "clean" repeal when in January he took credit for convincing President Donald Trump to support repeal legislation that would include provisions for replacing the ACA.

"It's great that Sen. Paul is willing to return to the original GOP strategy; it would have been better had he supported that approach in the first place," Matthews said.

After the Senate bill was abruptly pulled from consideration, Trump suggested lawmakers pass a bill that would just repeal the ACA and later worry about taking up replacement measures (Best's News Service, June 30, 2017).

White House legislative affairs director Marc Short said the president's new tactic is simply a reflection of the existing political landscape on Capitol Hill.

"The way we look at it is if the replacement part is too difficult for Republicans to come together," Short said on Fox News. "Then let's go back and take care of the first step in repeal. You have 50 members on record who have (previously) voted for that."

Short was referring to a 2015 vote in the Senate's under President Barack Obama, in which 49 of the current GOP senators voted to repeal ACA. He said it would be difficult for them to explain how they supported it then and would not support it now.

Trump's tweet apparently endorsed a plan by Nebraska Sen. Ben Sasse, a Republican, who wants to completely repeal the ACA, but delay the effect for one year to give lawmakers time to write a replacement plan. Sasse continued to defend his plan on CNN's State of the Union program.

"Republicans need to stop pretending that everything worked well in health care prior to 2010 when Obamacare was passed," Sasse said. "Democrats need to stop pretending that Obamacare is working."

"We should unbundle them. Republican gave their word," Sasse said. "We should delay its implementation date and all 100 senators should get before the American people on camera 18 hours a day in August."

The Democrats, which have been opposed to the GOP repeal efforts, agreed hearings on the Senate measure were needed.

Senate Finance Committee Ranking Member Sen. Ron Wyden, D-Ore., sent a letter to Senate Finance Committee Chairman Sen. Orrin Hatch, R-Utah, requesting full committee consideration of the Senate ACA repeal bill, the Better Care Reconciliation Act.

"To date, the Senate Finance Committee has not had a single hearing on BCRA or on the dramatic changes being proposed to Medicaid such as fundamentally restricting the program by putting a cap on the program and eliminating the Medicaid expansion and promised federal funding to states," the letter said.

Pennsylvania Insurance Commissioner Teresa Miller was sharply critical of the move to repeal the ACA with no ready replacement.

"Pennsylvanians need to keep this history in mind," Miller said in a statement, "and not allow their health care to be put in jeopardy with a vague promise that Congress will come up with something before an arbitrary deadline returns health insurance to the very consumer un-friendly situation that existed prior to the Affordable Care Act."

There would be fewer uninsured under a straight ACA repeal than under the Senate bill, according to a new analysis by the Urban Institute and the Robert Wood Johnson Foundation. The Congressional Budget Office found the Senate bill would lead to 15 million more people becoming uninsured next year than under Obamacare and 22 million more by 2026.

"When the Medicaid cuts are factored in, the overall impact of the Senate bill is estimated to exceed repealing the ACA altogether and replacing it with nothing," Katherine Hempstead, senior adviser at the Robert Wood Johnson Foundation, said in a statement.

A new Centers for Medicare and Medicaid Services report on the ACA reinsurance and risk adjustment programs shows they worked well last year. The predictability of the risk scores improved and were stable in the individual market and decreased in the small group market, the report said.

"The transitional reinsurance and permanent risk adjustment programs functioned smoothly for the 2016 benefit year," the report said. "The transitional reinsurance program continues to provide significant protection to individual market issuers with exceptionally high-cost enrollees."


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