Many Ways to Repeal and Replace Obamacare

The new Congress is convening, with Republicans preparing to dismantle Obamacare and Democrats threatening a fight to keep it in place.

Vice President-elect Mike Pence is planning to meet with House Republicans on Wednesday to discuss Obamacare repeal and replacement plans. Eager to save the signature piece of legislation of his presidency, President Barack Obama plans to meet with Democrats on the same day to strategize on how to fend off the GOP’s attacks.

But even now, with Republicans controlling both chambers of Congress and Donald Trump about to be inaugurated as president, there are doubts about whether the GOP will follow through with a repeal and replacement plan.

In November, Sen. Lamar Alexander (R-TN), chairman of the Senate Health, Education, Labor, and Pensions Committee, predicted it would take years to repeal and replace Obamacare, and that a new healthcare law would need to be a bipartisan effort.

“I imagine [it] will take several years to completely make that sort of transition to make sure we do no harm, create a good healthcare system that everyone has access to and we repeal the parts of Obamacare that need to be repealed,” Alexander said, according to The Hill.

“What we need to do is make lower-cost insurance available to most Americans,” he added. “The exchanges are the problem. They need to be repealed; the individual mandate needs to be repealed. … But I think what we need to focus on first is what we would replace it with and what are the steps we would take to do that.”

Writing at Forbes, John Goodman – a supporter of market-based healthcare solutions – asks his readers whether they consider it strange “that after 7 years, Republicans in Congress still don’t have a replacement plan for Obamacare.”

“Or that they now tell us that developing one will take 3 or 4 more years,” he continues. “And of course, once they have a plan it will take state governments and insurance companies two or three more years to phase it in. So, we are looking at a decade’s delay. That’s if we are lucky.”

“If Obamacare were a Republican reform and Democrats controlled Congress, how long would it take the Democrats to come up with a better plan?” Goodman asks. “They’d do it in a heartbeat.”

Rep. Tom Price of Georgia – Trump’s pick to run the Department of Health and Human Services – has been refining for years his own proposal to replace Obamacare, titled “Empowering Patients First Act.”

An orthopedic surgeon, Price told the Washington Examiner that fully repealing Obamacare is essential:

It needs to be fully repealed, because the first step out of the gate for Obamacare is a step in the wrong direction and that is for government control over every aspect of health care, so it’s hard to fix the system that they have put in place without ending that premise that government ought to be running and controlling health care.

However, Price is also a believer in universal coverage.

“Coverage is important, and our bill…we believe, provides not just an incentive, but the financial feasibility for every single American to purchase the coverage that they want,” he said, adding that “the system doesn’t work if people aren’t covered.”

Philip Klein at the Examiner provides a summary of Price’s plan:

It would repeal the text of Obamacare, and replace it with a system that would provide tax credits to individuals based on age. Though previous versions had varied the credits based on income, doing so by age is easier to administer (HHS won’t get into the problems it’s had with Obamacare in terms of verifying income for the purposes of the subsidies) and it also provides more money to those who have to pay more for insurance. In addition, there would be a one-time tax credit to put in a health savings account for routine medical expenses.

The Heritage Foundation recommends several steps to Republicans as they begin to repeal Obamacare. First, a maximization of the reconciliation process for repeal might be realized if Congress uses the road map of its prior repeal of major pieces of Obamacare – which was ultimately vetoed by Obama.

Second, Heritage suggests implementation of an “aggressive regulatory rollback” to help stabilize markets in the next two years and give consumers confidence.

Acceleration of action at the state level, such as the development of alternative insurance reforms that won’t raise the cost of insurance coverage, limit choice of providers, or drive down competition, is a third recommendation. Additionally, states that have expanded Medicaid will need to make adjustments, Heritage says.

Finally, the plan for replacement should begin this year, with a goal for legislation to be completed by the end of 2017, suggests Heritage.

In its latest newsletter, the Association of American Physicians and Surgeons (AAPS) worries that Republicans may actually “renege on the promises that returned them to power” for fear of turning off voters who will blame them for taking away their free birth control pills and other Obamacare “benefits.”

The professional group, which wants to see Obamacare repealed and a return to individualized, patient-centered care, notes that some Republicans want to continue at least some of Obamacare’s “benefits,” and that would require taxes. Consequently, some of the replacement plans suggested do not repeal Obamacare’s taxes.

Goodman says the issue of taxes and, more specifically, tax credits, is what divides establishment Republicans and conservatives and prevents a decision on an Obamacare replacement plan. That, and whether universal health insurance coverage should be a goal at all.

AAPS notes that many Americans lost their health insurance because Obamacare mandated “minimum” coverage requirements.

“[T]his misleadingly named mandate, which really means comprehensive coverage, is the most important driver of excessive costs and spending —and for relatively little benefit,” the group states, observing also that the requirement “can’t be repealed in budget reconciliation, which requires only a majority vote, because it is not recognized to affect revenue or taxes.”

Therefore, AAPS says the most important step to healthcare reform is to “move away from comprehensive coverage as the single financing model.”

The group recommends that individuals pay for routine medical expenses themselves, the costs for which will come down as competition increases; that more “predictable expenses” be taken care of through savings and credit; and that health insurance be used for catastrophic expenses.

“Failure of Republicans to understand this is one reason people will lose—drop— “insurance” if their taxpayer subsidies are withdrawn and coverage mandates continue,” AAPS concludes.

Sen. Rand Paul (R-KY) – an ophthalmologist – is urging Congress to repeal all of Obamacare and replace it immediately and simultaneously.

“All around us, Obamacare crumbles in chaos. Premiums are exploding,” Paul wrote in an  op-ed at Rare, “The state run health co-ops are mostly bankrupt. Many individuals who gained subsidized insurance are still, for all practical purposes, without insurance because the deductibles are beyond the reach of low income workers.”

For its replacement, Paul recommends that Americans “try freedom” for their health care:

1. The freedom to choose inexpensive insurance free of government dictates.
2. The freedom to save unlimited amounts in a health savings account.
3. The freedom to buy insurance across state lines.
4. The freedom for all individuals to join together in voluntary associations to gain the leverage of being part of a large insurance pool.

“If Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of Obamacare,” Sen. Paul warns. “For mark my words, Obamacare will continue to unravel and wreak havoc for years to come.”