House Republicans are expected to begin their efforts to repeal the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) through the budget reconciliation process when Congress returns from its Presidents Day recess period. However, Republican House and Senate leaders are still trying to determine which provisions of the health care law will be targeted and what, if anything, will replace it. The discussions are ongoing and will continue to evolve over the coming weeks.
House Republican leadership Feb. 16 circulated, “Obamacare Repeal and Replace: Policy Brief and Resources” to their members in advance of the Presidents Day congressional recess. The brief calls for a repeal of the ACA and provides a broad outline for a replacement plan, which includes expanding the use of Health Savings Accounts, eliminating the individual and employer mandate penalties, modernizing Medicaid through block grants or per capita allotments, creating state-based high-risk pools, and repealing Medicaid Disproportionate Share Hospital (DSH) cuts.
The House Freedom Caucus Feb. 14 released a statement urging the House to vote on the same language as the fiscal year (FY) 2015 budget reconciliation bill that President Obama vetoed, which would have revoked authority for the government to run healthcare exchanges, Medicaid expansion, and subsidies available to consumers to afford health care plans [see Washington Highlights, Jan. 8, 2016]. The caucus stated, “We made a commitment to the American people to repeal this law – we must keep that promise…There is no reason for Republicans to send anything less on repeal to President Trump’s desk than we did President Obama’s desk.”
As part of Republican efforts of moving smaller reform components, House Energy and Commerce Chair Greg Walden Feb. 16 introduced The Pre-Existing Conditions Act of 2017 to ensure that enrollees cannot have benefits excluded from a plan due to a pre-existing condition and that patients will not pay more based on their health care status.
During a Feb. 15 speech on the Senate floor, Senate Finance Committee Chair Orrin Hatch (R-Utah) stated his support for “moving quickly to repeal Obamacare and include as many replacement policies as possible under the rules of the reconciliation process.” Chairman Hatch specifically highlighted the need to repeal various taxes in the ACA, noting, “All told, the tax provisions of the Affordable Care Act represented a trillion dollar hit on the U.S. economy in the first ten years. And, the burdens of the vast majority of these taxes are ultimately borne by patients and consumers in the form of higher costs, larger tax bills, and reduced value in existing health plans and savings accounts.”
Chairman Hatch Feb. 16 introduced the bicameral Health Savings Act of 2017 (S. 403) in partnership with Sen. Marco Rubio (R-Fla.) and Rep. Erik Paulsen (R-Minn.) to expand Health Savings Accounts and Flexible Spending Accounts.
The House Energy and Commerce Committee is expected to hold a hearing on the ACA the week of Feb. 27, and would likely begin to mark-up the legislation the following week.