In early March, Republicans in the House of Representatives released their health care legislation. Intending to live up to their promises to repeal and replace the Affordable Care Act (or Obamacare), Republican congressmen and President Trump tried to get majority support to pass the American Health Care Act (AHCA), which they said would improve America’s health care system.
Ultimately, they failed to persuade enough Republicans to get a winning margin in Congress. However, they said that reform efforts weren’t over with the failure of this bill.
It is unclear what will happen now. There are differing perspectives on this issue from conservatives and liberals. With the GOP controlling Congress, the conservative direction seems more likely to prevail if some health care bill emerges in the legislative branch. But with an election occurring next year, it is possible that Democratic wins in 2018 could produce a liberal direction on health care reform in future years.
Here are some of the options being discussed in DC now:
Replace Obamacare: This is what the AHCA tried to do. It would have repealed some of Obamacare’s provisions and then enacted new provisions that tried to meet different health care goals. With the demise of the AHCA, President Trump and members of Congress have said they are continuing to work on ideas that would approach this issue from a different direction.
Repeal Obamacare: On the surface, this option is simple – all Congress has to do is repeal the legislation passed in 2010. Then, in theory, the health care marketplace would go back to its pre-Obamacare days. However, a lot has changed in the health care world in the past seven years. Individuals and companies have taken steps to comply with the ACA. Even in the world before ACA, there was heavy government involvement in health care. Many conservatives would like to see reforms that deal with the problems they saw in 2010 with the level of government regulation at the time. Repealing the ACA will not be enough for them.
Block-grant Medicaid: Instead of a wholesale repeal and/or replacement of the ACA, some conservatives would like Congress to focus on block granting Medicaid. The Medicaid program provides health coverage for people with disabilities, the poor and the near-poor. As a joint state-federal program, some conservatives see Medicaid as an opportunity to give states an ability to experiment with different methods of providing health care. Right now, the federal government provides funds to states based on the state’s income level and enrollment. Under a block grant, states would receive a set amount of money, but in return would have more freedom to innovate.
Single-payer: Under “Medicare for All” legislation, the federal government would pay for every American’s health care. Private companies could offer supplemental insurance, but health care would largely be a government-run system.
Expanded Medicaid: Under the ACA, the federal government provides incentives for states to expand their Medicaid programs to cover people who make up to 138% of the federal poverty level. Some liberals have called on the federal government to raise that cap, which would likely lead to more states expanding Medicaid to larger groups of people.
The status quo
Until Congress passes legislation, the ACA is still the law of the land. Its provisions will continue to be in effect. The federal government will enforce the law. However, that raises some issues, since the executive branch tasked with overseeing the ACA is headed by President Trump.
The new president has two options. One would be to do all he can to make the law work efficiently. Another would be to direct federal agencies not to fix issues as they come up with the law. The second seems more likely, as the president has tweeted “ObamaCare will explode…” However, it’s unclear exactly what path the Trump Administration will take when it comes to implementing the ACA. Regardless, the ACA will exist and be operational until there is a change in federal health care law.
What do you think Congress should do about health care reform?