Repeal and Delay: Emphasis on “Delay”

At the start of President Trump’s term, Republicans in Congress planned to repeal the Affordable Care Act (ACA), better known as Obamacare, without a replacement plan to replace it. This “repeal and delay” tactic did not sit well with Democrats and many Republicans, nor was it acceptable to President Donald Trump, who wanted to “repeal and replace former President Obama’s signature healthcare law. Public outcry and pushback from both parties has led the GOP to release the American Health Care Act (ACHA) in an effort to have a plan ready to replace the ACA once it is officially repealed.

However, the AHCA (Trumpcare) has been met with significant backlash from both sides of the congressional aisle, with many claiming that premiums will rise, millions will lose healthcare and that it will create uncertainty in the insurance market. These factors have led many Americans to wonder what other promises made during the election may be “delayed” as Congress wrestles with healthcare.

Lower Health Insurance Premiums

One promise made throughout the campaign by President Trump and his Republican counterparts was that repealing Obamacare and replacing it with the GOP plan would reduce healthcare costs. However, the Congressional Budget Office, a non-partisan organization that provides information to Congress on budget and policy matters, reported that health insurance premiums would actually rise, possibly even significantly, in the first few years of the plan.

In a meeting with small business leaders in early March, President Trump warned that lower premiums could be delayed by a year or two. The Republican plan immediately eliminates the individual mandate that levies an IRS penalty against Americans who do not have health insurance. Analysts believe that this will lead healthy people to pull themselves from the insurance marketplace, causing insurance premiums to rise at first. The reason for this is that health insurance companies are in the process of setting rates for next year and will more than likely err on the side of caution by raising rates due to uncertainty.

Delay in Cost-Saving Portions

Republicans have already taken steps to repeal the ACA using what is known as budget reconciliation, the same method used by Democrats to pass the law initially. Under budget reconciliation, only portions of law that deal with spending and revenue can be considered. One reason Congress uses the budget reconciliation process is that debate on the bills is limited to 20 hours, eliminating the ability of the opposing party to filibuster.

Unfortunately, only portions of the ACA that are connected to the budget, such as revenues from tax penalties or subsidies that provide discounts to low-income families to purchase insurance, can be repealed with budget reconciliation. President Trump and other GOP leaders say that there are cost-saving measures in the Republican plan that will lower premium costs, such as the ability to purchase insurance across state lines and drug-price negotiations, but these can’t be implemented until Obamacare is completely repealed.

Because these are expected to be included in separate legislation as they won’t have time to take effect when the ACA is repealed, they will not have an impact on next year’s rates, leading to an additional delay in at least one cost-saving option under the GOP plan.

Lack of Support for GOP Plan

There is significant lack of support for the AHCA as it’s currently written. Speaker of the House Paul Ryan and other AHCA supporters have been rallying support among moderate conservatives, offering amendments intended to sweeten the deal. Even recently confirmed Secretary of Health and Social Services Tom Price has expressed concerns about the bill’s phase out of Medicaid expansion, which could leave 11 million lower-income Americans without insurance.

Conservative lawmakers feel that the bill is too much like the ACA. They want to see Medicaid expansion eliminated immediately. They also claim that the tax credits offered under Trumpcare are too generous and demand that all mandates be eliminated. This includes coverage of special services like substance abuse counseling. Many Republican leaders, not to mention news outlets and political analysts, do not believe they have enough support even in their own party for the bill as written.

From the beginning, both Democrat and Republican leaders have said that repealing Obamacare would be very difficult as the bill is intertwined in numerous government agencies. Repealing all of the ACA will take time, which is why many on both sides of the political spectrum are wondering why there is a strong push to pass the AHCA with such little support. Most suggest a delay in both repealing Obamacare and passing a replacement plan, allowing leaders to address the various components of the complicated ACA and creating a replacement that will be beneficial to all Americans, rather than just a few. It remains to be seen how these delays will affect healthcare over the next few years, but uncertainty is already causing problems in the insurance industry.