Several media outlets have reported widespread opposition in
Congress and the American public against repealing the Affordable Care Act without replacing it.
Barack Obama has stated that "The Republicans will own the problems with the health care system if they choose to repeal something that is providing health insurance to a lot of people".
Early proposals The proposed CARE Act reverts many of the benefits of the Affordable Care Act. Senator
Rand Paul had said he planned to introduce a replacement plan during the week of January 9, 2017. One key provision in his plan was to offer cheaper, less robust insurance plans for people. Senators
Susan Collins (Maine) and
Bill Cassidy (La.) introduced their plan, the
Patient Freedom Act of 2017, on January 23, 2017, which would offer states the option to retain the Affordable Care Act, if they chose, or receive a block grant to be used on an alternative plan they prefer.
House legislation American Health Care Act A comprehensive plan to replace the Affordable Care Act was announced by the House Republican leadership on March 6, 2017. It retains many features of the Affordable Care Act, but replaces ACT's system of subsidies with tax credits and federally-funded
Medicaid coverage with a system of block grants to states based on the nature and number of recipients served. Conservative critics such as
Rand Paul characterized the plan as "Obamacare Light" and continued to advocate total repeal, while other Republicans such as
Cory Gardner from states which had accepted Medicaid expansion expressed worry about whether the new plan would adequately fund services for Medicaid patients. The
United States House Committee on Ways and Means approved one portion of the bill on March 9, 2017, after an all-night session. The second portion of the bill was also approved March 9 by the
United States House Committee on Energy and Commerce on a party-line vote. On March 13 the
Congressional Budget Office released its evaluation of the proposal. It projected a rise in uninsured by 24 million by 2028, but savings of $337 billion over ten years. In 2018, most of the reduction would be caused by the elimination of the penalties for the individual mandate, both directly and indirectly. Later reductions would be due to reductions in Medicaid enrollment, elimination of the individual mandate penalty, subsidy reduction, and higher costs for some persons. By 2016 the CBO estimates that the average amount paid for medical insurance would decrease by about 10%. That results from increased prices for older patients and reduced credits which is predicted to increase the proportion of younger people in the pool and reduce the proportion of older people. The bill was approved by the
House Budget Committee 19 to 17 on March 16, 2017. Three members of the
Freedom Caucus,
Dave Brat (Va.),
Mark Sanford (S.C.) and
Gary Palmer (Ala.) voted against it. It went next to the
House Rules Committee, On March 24, 2017, the bill was withdrawn by Speaker
Paul Ryan (with the endorsement of
President Donald Trump) after failing to gain enough support in the
House of Representatives. On May 4, 2017, the United States House of Representatives narrowly voted to repeal the Patient Protection and Affordable Care Act and passing the American Health Care Act with a narrow vote of 217 to 213, sending the bill to the Senate for deliberation. The Senate indicated they would write their own version of the bill, instead of voting on the House version.
Other legislation On March 7, 2017
Pete Sessions sponsored an alternate proposal to
repeal and replace the Patient Protection and Affordable Care Act entitled the "
World's Greatest Healthcare Plan of 2017". The bill's current format removes the ACA's
individual mandate, which taxed individuals without health insurance. Moreover, it maintains some aspects of the ACA including ensuring insurance coverage for pre-existing conditions, allowing children to stay on their parents' health care until they are 26 years old, and banning the use of lifetime spending limits by insurance companies.
Senate legislation In response to the passage of the
AHCA in the House, Republican leadership in the Senate stated that they would draft their own version of the legislation instead of bringing the House's version to a vote. Thirteen senators began meeting behind closed doors to draft the legislation. The group was criticized for not including women senators. In a meeting of the
Senate Finance committee, Senator
Claire McCaskill asked chairman Senator
Orrin Hatch why no
congressional hearings had been held on the proposed legislation. Video of the exchange went
viral. In addition to forgoing normal hearings and
legislative markup, Senate Republicans instituted new rules to limit the ability of reporters to ask senators about the legislation. When asked if Senate Republicans planned to release the text of the bill to the public, a Senate aide told
Axios, "We aren't stupid." According to
Don Ritchie,
Historian Emeritus of the Senate, such a secretive process has not been seen in the Senate in over a hundred years. On June 16, 2017, a
bipartisan group of seven current
governors sent a letter to
Senate Majority and Minority Leaders Mitch McConnell and
Chuck Schumer criticizing the House's legislation and requesting a bi-partisan effort in the Senate to reform healthcare. The signatories include Governors
John Kasich (
Ohio),
Steve Bullock (
Montana),
Brian Sandoval (
Nevada),
John Bel Edwards (
Louisiana),
John Hickenlooper (
Colorado),
Charlie Baker (
Massachusetts), and
Tom Wolf (
Pennsylvania). On July 18, 2017, the healthcare bill in the Senate collapsed following the defections of Senators Mike Lee of Utah and
Jerry Moran of Kansas, making them the third and fourth Republicans to defect. President Donald Trump expressed his disappointment and indicated he would "let Obamacare fail". On July 25, a procedural vote was passed by the Senate to begin debate on the healthcare bill, 51–50 with Vice President Mike Pence breaking the tie. The same day, the bill was soundly defeated 43–57, with nine Republicans defecting and no Democrats or Independents voting for the bill. As the effort to repeal and replace the Affordable Care Act was stalled, Senate Majority Leader
Mitch McConnell scheduled a vote on a partial-repeal amendment. This too was defeated, 45–55, with 7 Republicans defecting. Subsequently, a "skinny repeal" of the healthcare bill was voted on in the early hours of July 28. The decisive vote against their own party's bill was cast by Senators
John McCain,
Susan Collins and
Lisa Murkowski; their vote along with the Democrats defeated the bill 49–51. On September 13, 2017, an amendment to the American Health Care Act, commonly known as
Graham-Cassidy, was submitted. The bill is sponsored by
Lindsey Graham of South Carolina, with
Bill Cassidy of Louisiana as a co-sponsor. A spokesman for the Senate Majority Leader
Mitch McConnell said that a vote is planned for, before September 30 which is the deadline to pass bills under budget reconciliation.
Rand Paul and John McCain indicated that they would vote against the bill. On September 26, 2017, Senate Majority Leader Mitch McConnell announced that the Senate would not vote on the Graham-Cassidy bill.
Administration The Trump administration ended subsidy payments to health insurance companies, in a move expected to raise premiums in 2018 for middle-class families by an average of about twenty percent nationwide and cost the federal government nearly $200billion more than it saved over a ten-year period. The administration made it easier for businesses to use health insurance plans not covered by several of the ACA's protections, including for preexisting conditions, and allowed organizations not to cover birth control. In justifying the action, the administration made false claims about the health harms of contraceptives. The administration proposed substantial spending cuts to
Medicare,
Medicaid and
Social Security Disability Insurance. Trump had previously vowed to protect Medicare and Medicaid. The administration reduced enforcement of penalties against nursing homes that harm residents. As a candidate and throughout his presidency, Trump said he would cut the costs of pharmaceuticals. During his first seven months in office, there were 96 price hikes for every drug price cut. Abandoning a promise he made as candidate, Trump announced he would not allow Medicare to use its bargaining power to negotiate lower drug prices. ==References==