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ACA Deathwatch: the GOP’s “repeal”

If you are confused and frustrated with the Republicans’ moves to repeal and replace ACA, rest assured they are way more frustrated – and more than a little concerned – than you are.


Here’s what’s going on.

There are two main issues.

  1. Repeal without replacement is a budgetary and political minefield.
  2. Congressional Republicans aren’t even close to agreeing on what a replacement bill would look like

Republicans are working to finalize a bill that would defund major parts of ACA. There is NO consensus among Republicans on the details of this bill – and won’t be until at least January 27 (don’t be surprised if the replacement bill isn’t ready till well after January 27…). This won’t require any Democratic support as it is a budget bill. The GOP will own the bill – and the bill’s repercussions.

Earlier this week the CBO gave us a taste of what a repeal without credible replacement would look like, and that taste was bitter indeed.

  • 18 million would lose health insurance within twelve months
  • Premiums would jump by 20 percent to 25 percent immediately

BTW the CBO’s Director was appointed by Republicans in 2015.

If the GOP moves forward with repeal without a replacement bill – which looks highly likely – it will get hammered by Democrats in what will be reminiscent of the Tea Party’s assault on Democrats during ACA’s passage. Dems will turn the tables on Republicans, and with voters primed to fear losing coverage, the message will resonate.

The GOP’s problem is simple – ACA funding is very complex and cutting funding (which is how Republicans are “repealing” ACA);

  • decreases the number of people with insurance and/or
  • increases state government budget deficits and/or
  • increases the federal deficit and/or
  • hurts Medicare, and/or
  • hurts hospitals, and/or
  • hurts insurers.

There’s intense lobbying going on as device manufacturers, hospitals, governors, insurance companies, the very wealthy and other special interests seek to protect themselves.

While Republicans do have “plans” to replace ACA, they do NOT have consensus on “A plan”.  There’s a plan from HHS Secretary nominee Tom Price, another from Speaker Ryan, other plans based on prior GOP bills, plus lots of ideas from GOP-affiliated think tanks and lobbying groups. Make no mistake, there’s a lot of ideological division among Congressional Republicans.

When the GOP does write a replacement bill, it will be scored by the CBO.  A part of that scoring has to do with the definition of health insurance. Up till now, CBO used the ACA’s definition; now that ACA is going away, it will revert to the previous definition.  Not to get too deep in the weeds here, but that’s NOT good news for the GOP.

The dilemma facing Republicans is simple; there’s no way they can deliver on their promises to ensure people don’t lose coverage, reduce costs, and improve access.

Republicans are about to pull a Wile E Coyote, running full speed off the cliff. Given Democrats’ amazing ability to turn certain victory into crushing defeat by losing the messaging battle, the GOP may make it to the other side unscathed.

What does this mean for you?

The CBO is the key.

4 thoughts on “ACA Deathwatch: the GOP’s “repeal””

  1. Thanks Joe. There was a lot of talk about Obamacare being a train wreck and that Dems would take a huge hit for pushing it through and that it would be political suicide. They pushed it anyway, shoved it down the American people’s throats. And they paid dearly for it in the elections and Americans paid dearly for it in their wallets. So the predictions and fear came true. Now according to your posts, Republicans are faced with the same type of scenario. They are going to try and fix the things that are hurting Americans and in so doing are going to make things worse, thus committing political suicide and upsetting Americans. It will be interesting to see if the same thing happens to the Republicans that happened to the Dems. It sure seams like a political battle with the American people caught in the middle. I don’t have an answer. I just think it is extremely difficult for either side to “win” or make everyone happy. If Obamacare stays than millions financially suffer. If it changes and preexisting conditions are no longer covered than millions suffer. What’s the answer? I would like to see cheap plans sold and have the mandate waived and at the same time have preexisting conditions covered all while avoiding a socialistic program of taking from the middle class/under middle class and wealthy and giving to the poor. But according to the architect of the program without the mandate (tax) Obamacare fails. There has to be some kind of balance there to ease and help all parties…but maybe that is a pipe dream.

    1. Hi Spencer – thanks for the note. I’d suggest the problems with ACA were exacerbated by the failure of Senate Republicans to negotiate in good faith when the original bill was being drafted. The Dems spent months working with three Republican senators, in the process drastically changing the original bill to meet Republican demands:

      – remove the public option
      – reduce the tax/penalty for those who didn’t sign up
      – add the “Cadillac tax”
      – add the religious exemption
      – add ability to participate in “faith-based” pseudo-insurance programs
      – gut the IPAB and prohibit any consideration of cost or outcomes in management of medicare or medicaid

      I could go on, but you get the picture. When Enzi, Snowe, and Grassley backed out of the “Gang of Six” under huge pressure from McConnell, the Dems stuck with their commitments and passed the bill with them included.

      One major reason premiums have increased is the gutting of the 3Rs program (discussed in detail here – just search for “rubio” in the search box). This killed risk adjustment payments, led to bankruptcy of Co-Ops, and withdrawal of many plans from exchanges.

      I’d also note – and this is CRITICAL – that ACA extended the life of Medicare by a dozen years, and was NOT funded by taxes on the middle class. in fact, taxes were targeted to those making more than $200k a year.

      Finally, the ACA fixed a big problem with the GOP’s Medicare Part D program – the “doughnut hole”. Unfortunately, the republicans refused to work with Dems to fix some of the problems w ACA, choosing instead to litigate, cut funding, and gut the original bill.

  2. This is a huge issue that impacts every person in the United States. I am so sick and tired of the constant finger pointing that each side uses to sure up their position. The Rs have had 6 years to come up with a replacement plan and today, when they are repealing the bill they have nothing. Give me a break. This is a huge issue, that impacts every one of us. Get to work and do it right.

  3. I have a son using the ACA and able to get affordable care. My company’s premium increases are no longer in double digits but still too high. I pay more taxes and am fine with this. I also understand insurance and know you can’t have people free-loading by not having coverage and then getting free care or complaining about the bill collectors.

    The people complaining about the ACA largely benefit from it and will be hurt deeply if it ends. Other than those in the very top incomes who can afford any system.

    The GOP is now stuck. Politics give way to reality. I await hearing about their actuarilally sound alternative? They’d like a plan where all the sick are covered at will, the healthy can opt out or buy a plan after they are sick or pregnant that is priced as if they aren’t, and more.

    I look forward to this because if they can pull it off I will cancel my auto and homeowners since they’ll also figure out a way for me to have an app that buys insurance when my car senses an imminent accident or when my smoke detector indicates a fire.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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