 | This article needs to beupdated. Please help update this article to reflect recent events or newly available information.(July 2017) |
| This article is part ofa series on |
| Healthcare reform in the United States |
|---|
Legislation
|
Third-party payment models |
 United States portal Health care portal |
The following is a list of plans which were considered to replace theAffordable Care Act (commonly referred to as the ACA or Obamacare) during theDonald Trump administration. The plans were considered after theRepublican Party gained a federalgovernment trifecta in2016. "Repeal and replace" has been a Republican slogan since March 2010 when the ACA was signed into law. The slogan was adopted by PresidentDonald Trump.[1]
PresidentDonald Trump and manyRepublicans have vowed to repeal and replace Obamacare; President Trump signedan executive order on January 20, 2017, his first day in office, that according toWhite House Press SecretarySean Spicer would "ease the burden of Obamacare as we transition from repeal and replace". Spicer would not elaborate further when asked for more details.[2][3][4]
On January 12, 2017, the Senate voted 51 to 48 to pass anFY2017budget resolution,S.Con.Res. 3, that contained language allowing the repeal of theAffordable Care Act through thebudget reconciliation process, which disallows afilibuster in the Senate.[5][6][7][8][9] In spite of efforts during the vote-a-rama (a proceeding in which each amendment was considered and voted upon for about 10 minutes each until all 160 were completed) that continued into the early hours of the morning, Democrats could not prevent "the GOP from following through on its repeal plans."[7][10]
Several media outlets have reported widespread opposition inCongress and the American public against repealing the Affordable Care Act without replacing it.Barack Obama has stated that "The Republicans will own the problems with the health care system if they choose to repeal something that is providing health insurance to a lot of people".[11]
The proposed CARE Act reverts many of the benefits of the Affordable Care Act.[citation needed]
SenatorRand Paul had said he planned to introduce a replacement plan during the week of January 9, 2017.[12] One key provision in his plan was to offer cheaper, less robust insurance plans for people.[13]
SenatorsSusan Collins (Maine) andBill Cassidy (La.) introduced their plan, thePatient Freedom Act of 2017, on January 23, 2017, which would offer states the option to retain the Affordable Care Act, if they chose, or receive a block grant to be used on an alternative plan they prefer.[14][15]
A comprehensive plan to replace the Affordable Care Act was announced by the House Republican leadership on March 6, 2017. It retains many features of the Affordable Care Act, but replaces ACT's system of subsidies with tax credits and federally-fundedMedicaid coverage with a system of block grants to states based on the nature and number of recipients served. Conservative critics such asRand Paul characterized the plan as "Obamacare Light" and continued to advocate total repeal, while other Republicans such asCory Gardner from states which had accepted Medicaid expansion expressed worry about whether the new plan would adequately fund services for Medicaid patients.[19]
TheUnited States House Committee on Ways and Means approved one portion of the bill on March 9, 2017, after an all-night session.[20] The second portion of the bill was also approved March 9 by theUnited States House Committee on Energy and Commerce on a party-line vote.[21] On March 13 theCongressional Budget Office released its evaluation of the proposal. It projected a rise in uninsured by 24 million by 2028, but savings of $337 billion over ten years. In 2018, most of the reduction would be caused by the elimination of the penalties for the individual mandate, both directly and indirectly. Later reductions would be due to reductions in Medicaid enrollment, elimination of the individual mandate penalty, subsidy reduction, and higher costs for some persons.[22][23] By 2016 the CBO estimates that the average amount paid for medical insurance would decrease by about 10%. That results from increased prices for older patients and reduced credits which is predicted to increase the proportion of younger people in the pool and reduce the proportion of older people.[24][25] The bill was approved by theHouse Budget Committee 19 to 17 on March 16, 2017. Three members of theFreedom Caucus,Dave Brat (Va.),Mark Sanford (S.C.) andGary Palmer (Ala.) voted against it.[26] It went next to theHouse Rules Committee,[26] then to the full House.[20] The bill, once it passed the House, would go to the Senate underbudget reconciliation rules. Thus, only material which affects the budget can be included and only a simple majority vote will be required in the Senate. Despite his vow not to get involved into day-to-day politics former President Obama became a part of the discussion on March 23, 2017 (the seventh anniversary of ACA and one day prior to the vote on the American Health Care Act) by hailing among other things 20 million more people insured, preexisting conditions covered, young people staying on their parents' plans until 26, lowered costs for women's health care and free preventive care as progress due to the Affordable Care Act.[27][28] On March 24, 2017, the bill was withdrawn by SpeakerPaul Ryan (with the endorsement ofPresident Donald Trump) after failing to gain enough support in theHouse of Representatives.[29]
On May 4, 2017, the United States House of Representatives narrowly voted to repeal the Patient Protection and Affordable Care Act and passing the American Health Care Act with a narrow vote of 217 to 213, sending the bill to the Senate for deliberation.[30] The Senate indicated they would write their own version of the bill, instead of voting on the House version.[31]
On March 7, 2017Pete Sessions sponsored an alternate proposal torepeal and replace the Patient Protection and Affordable Care Act entitled the "World's Greatest Healthcare Plan of 2017".[32] The bill's current format removes the ACA'sindividual mandate, which taxed individuals without health insurance. Moreover, it maintains some aspects of the ACA including ensuring insurance coverage for pre-existing conditions, allowing children to stay on their parents' health care until they are 26 years old, and banning the use of lifetime spending limits by insurance companies.[33]
In response to the passage of theAHCA in the House, Republican leadership in the Senate stated that they would draft their own version of the legislation instead of bringing the House's version to a vote. Thirteen senators began meeting behind closed doors to draft the legislation.[34] The group was criticized for not including women senators.[35][36] In a meeting of theSenate Finance committee, SenatorClaire McCaskill asked chairman SenatorOrrin Hatch why nocongressional hearings had been held on the proposed legislation.[37][38] Video of the exchange wentviral.[39] In addition to forgoing normal hearings andlegislative markup, Senate Republicans instituted new rules to limit the ability of reporters to ask senators about the legislation.[40] When asked if Senate Republicans planned to release the text of the bill to the public, a Senate aide toldAxios, "We aren't stupid."[41] According toDon Ritchie,Historian Emeritus of the Senate, such a secretive process has not been seen in the Senate in over a hundred years.[42]
On June 16, 2017, abipartisan group of seven currentgovernors sent a letter toSenate Majority and Minority LeadersMitch McConnell andChuck Schumer criticizing the House's legislation and requesting a bi-partisan effort in the Senate to reform healthcare. The signatories include GovernorsJohn Kasich (Ohio),Steve Bullock (Montana),Brian Sandoval (Nevada),John Bel Edwards (Louisiana),John Hickenlooper (Colorado),Charlie Baker (Massachusetts), andTom Wolf (Pennsylvania).[43][44]
On July 18, 2017, the healthcare bill in the Senate collapsed following the defections of Senators Mike Lee of Utah andJerry Moran of Kansas, making them the third and fourth Republicans to defect. President Donald Trump expressed his disappointment and indicated he would "let Obamacare fail".[45]
On July 25, a procedural vote was passed by the Senate to begin debate on the healthcare bill, 51–50 with Vice President Mike Pence breaking the tie. The same day, the bill was soundly defeated 43–57, with nine Republicans defecting and no Democrats or Independents voting for the bill. As the effort to repeal and replace the Affordable Care Act was stalled, Senate Majority LeaderMitch McConnell scheduled a vote on a partial-repeal amendment. This too was defeated, 45–55, with 7 Republicans defecting. Subsequently, a "skinny repeal" of the healthcare bill was voted on in the early hours of July 28. The decisive vote against their own party's bill was cast by SenatorsJohn McCain,Susan Collins andLisa Murkowski; their vote along with the Democrats defeated the bill 49–51.[citation needed]
On September 13, 2017, an amendment to the American Health Care Act, commonly known asGraham-Cassidy, was submitted. The bill is sponsored byLindsey Graham of South Carolina, withBill Cassidy of Louisiana as a co-sponsor.[46] A spokesman for the Senate Majority LeaderMitch McConnell said that a vote is planned for, before September 30 which is the deadline to pass bills under budget reconciliation.[47][48][49]Rand Paul and John McCain indicated that they would vote against the bill.[50]
On September 26, 2017, Senate Majority Leader Mitch McConnell announced that the Senate would not vote on the Graham-Cassidy bill.[51]
The Trump administration ended subsidy payments to health insurance companies, in a move expected to raise premiums in 2018 for middle-class families by an average of about twenty percent nationwide and cost the federal government nearly $200 billion more than it saved over a ten-year period.[52] The administration made it easier for businesses to use health insurance plans not covered by several of the ACA's protections, including for preexisting conditions,[53] and allowed organizations not to cover birth control.[54] In justifying the action, the administration made false claims about the health harms of contraceptives.[55]
The administration proposed substantial spending cuts toMedicare,Medicaid andSocial Security Disability Insurance. Trump had previously vowed to protect Medicare and Medicaid.[56][57] The administration reduced enforcement of penalties against nursing homes that harm residents.[58] As a candidate and throughout his presidency, Trump said he would cut the costs of pharmaceuticals. During his first seven months in office, there were 96 price hikes for every drug price cut.[59] Abandoning a promise he made as candidate, Trump announced he would not allow Medicare to use its bargaining power to negotiate lower drug prices.[60]
A concurrent resolution setting forth the congressional budget for the United States Government for fiscal ...
{{cite web}}: CS1 maint: numeric names: authors list (link)The House Republican plan to repeal and replace the Affordable Care Act would raise the number of people without health insurance by 24 million within a decade, but would trim $337 billion from the federal deficit over that time, the nonpartisan Congressional Budget Office said on Monday.
CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period. CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
The C.B.O. estimates that the price an average 64-year-old earning $26,500 would need to pay after using a subsidy would increase from $1,700 under Obamacare to $14,600 under the Republican plan.