ACA Still Intact for Now, But for How Long?

Now that President Donald Trump has taken office legislative efforts to "repeal and replace" the Affordable Care Act (ACA) have begun in earnest. Both the House of Representatives and the Senate voted—though not without controversy and much debate—to approve a budget resolution that is a first step towards repealing the ACA through a budget reconciliation measure. As we indicated in our November issue of National Intelligence Report, legislation to repeal the ACA would need 60 votes in the Senate to pass, unless it was part of budget reconciliation legislation, which only requires approval by a simple majority.

That resolution called for a plan to be proposed by Jan. 27 regarding repeal and replacement for Obamacare but that deadline passed as we went to press without any proposals formally put forward. President Trump has indicated several times his goal is for repeal and replacement to happen at the same time.

Before his term ended, President Barack Obama wrote an article published in the New England Journal of Medicine, which described any plan to repeal ACA without a replacement at the same time as "reckless." He did concede that there was further work to do even if ACA remained in place but cautioned that "health care reform requires an evidence-based, careful approach, driven by what is best for the American people." He defended the individual responsibility requirement of the ACA, saying that the pre-existing condition protection depends on it and together with financial assistance such responsibility "is the only proven way to provide affordable, private, individual insurance to every American."

Rep. Greg Walden, chair of the House Energy and Commerce Committee stated in an interview with CNN in late January that Republicans are committed to protecting coverage for pre-existing conditions and for allowing offspring to remain on parents' insurance through age 26. A House Energy and Commerce Commission statement at the end of January announced that its subcommittee on health would be holding a hearing in early February regarding "four practical bills to give patients cost relief from Obamacare, tighten enrollment gaps, and protect taxpayers."

Takeaway: Repeal and replacement of the ACA remain on the front burner for legislators but the proposals for achieving that objective have yet to be finalized.