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ACA Repeal and Other Healthcare Issues on the Trump Administration's Agenda

Laura Joszt
Since the Republican bill to repeal and replace Obamacare never made it to a vote, insurers are still very uncertain about the future of healthcare. At this time it is unclear whether Republicans plan to shore up the law or actively undermine it.
Since the Republican bill to repeal and replace Obamacare never made it to a vote, insurers are still very uncertain about the future of healthcare. At this time it is unclear whether Republicans plan to shore up the law or actively undermine it.
 
In a session at the Academy of Managed Care Pharmacy Annual Meeting, held March 27-30 in Denver, Colorado, Stephen Northrup, MPA, and Stacey Rampy, JD, partners at Rampy Northrup LLC, outlined why Republicans couldn't pass the bill even with majorities in the House and the Senate, potential Republican action on healthcare in the future, and other healthcare issues that the Trump administration will face in the short term.
 
According to Northrup, one of the biggest reasons why the American Health Care Act failed to have enough votes to pass the House was the lack of consensus among Republicans on how to repeal and replace the Affordable Care Act (ACA) despite having talked about doing just that for 7 years.
 
“There was broad consensus around repeal but no consensus on replace,” he said. “And it’s shocking when you think about it that Republicans have been talking about repealing Obamacare and replacing it with something better since 2010.”
 
He contrasted what happened with Democrats, who had control of the House and the Senate when former President Barack Obama was pushing to pass the ACA. Democrats knew what they wanted to do with the ACA.
 
Rampy explained that Obama had 3 goals when he started the process of creating legislation for healthcare reform: reduce the number of uninsured, improve outcomes, and reduce insurance costs. Northrup added that coverage expansion took the lead with the idea that addressing costs would be addressed later once coverage was in place. The GOP’s belief that the ACA is no good and Republicans can do better is not a goal and is not enough to get consensus to pass legislation, he explained.
 
“Republicans have never really had clarity on their own goals and until Republicans gain clarity on their goals, it’s hard for me to see where they come up with the consensus on the path forward,” Northrup said.
 
Further complicating the matter was the mismatch between policy and procedure—in other words trying to repeal a major piece of legislation through the reconciliation process, which doesn’t really allow for such a complete repeal.
 
Lastly, the factions within the Republican Party were the ultimate reason the bill was killed. Republican leadership in the House was stuck in the middle of hardcore conservatives, who wanted to repeal the law entirely and scale back costs, and moderate Republicans, who were concerned with a loss of coverage and less concerned about entitlements for the middle class, Northrup said. In reality, there were a lot of aspects of the American Health Care Act that hardcore conservatives should have been pleased with.
 
“Cutting entitlements and cutting taxes: these are things the conservatives have been pushing for years,” Northrup said. “But they were unhappy with so many other provisions of the bill that they couldn’t see the big picture.”
 


 
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