Repeal and Replacement of the Affordable Care Act

February 2, 2017


After seven years of successive failed attempts to repeal President Barack Obama’s signature health care law, Congressional Republicans prevailed in approving budgets in the House and the Senate the second week of January which will ease passage of a still-unwritten bill to replace the Affordable Care Act (ACA). The measure does not require the president’s signature. Republicans will now use the procedural tool known as reconciliation, which allows for passage on a simple majority, to advance the legislation.

While the approval of the budgets sets into motion the repeal of the ACA, which President Trump has urged occur rapidly, replacement legislation, and its details, remains weeks or months away. Speaker Paul Ryan has stated he would not offer a firm timeline on when a final repeal bill would be ready.

Congressional Republicans and President Donald Trump have argued that repeal of the ACA is necessary because the law has not achieved its goal of reducing medical care costs while at the same time many consumers have faced narrowed insurance plans which limit access on choice of providers.

Many congressional Republicans, as well as many GOP governors in states that expanded their Medicaid programs under the ACA, have expressed opposition to leaders’ initial plans to repeal the ACA before coming up with a replacement, which could risk leaving consumers without coverage for an extended period of time.

Democrats have expressed support for taking steps to improve the law to address deficiencies, but have highlighted the law’s success in expanding health insurance to a record number of Americans. Nearly 20 million Americans receive health insurance through provisions of the ACA. In 2015, a record-level low 9.1 percent of Americans lacked health insurance coverage. The number of people uninsured in 2011, when provisions of the ACA first went into effect, stood at 15.1 percent. Democrats have urged that any replacement provide coverage to at least as many Americans as receive coverage under the ACA.

Replacement Legislation

President Trump has promised that the ACA will be replaced with something “far less expensive and far better” and that the replacement will provide “insurance for everybody” but the Administration has not released specific details on the replacement plan. In addition, significant differences remain within the Republican Party over what a replacement plan should entail, its timeline, and how it should be paid for.

President Trump has strongly advocated that insurers should be permitted to sell health insurance plans across state lines to increase competition and provide consumers with more choice. President Trump has promised to release the details of his replacement plan when Tom Price, his nominee for Secretary for the Health and Human Services, is confirmed by the Senate.

Although Republicans were able to utilize the reconciliation process to advance the repeal of the ACA without the risk of a Senate filibuster, they will need to find at least some Democratic support to replace the law as the reconciliation process can only be used to address taxing and spending policy.

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