ACA Alliteration: Republicans Rush Repeal Replace


January 13, 2017

A few weeks ago, we outlined what we thought would happen with the repeal and replace of the Affordable Care Act (ACA). We stand by our predictions and explanation of process, but lately we are starting to wonder if everything we ever knew to be true (at least from a political perspective about process) was wrong. But before we get too melancholy (too late?), let’s recap what's happened recently.

Early Thursday morning, the Senate voted to advance a budget resolution that sets in motion the ACA repeal process. This outcome was expected, though it came after a marathon “vote-a-rama” exercise that included roll-call votes on numerous amendments. Notably, the amendments voted down included a measure that would allow importation of drugs from Canada, and a general amendment addressing drug pricing—amendments, no doubt, fueled by President-Elect Trump’s remarks at his press conference saying that the pharmaceutical industry was "getting away with murder” and that the government should start bidding for drugs. The House is expected to vote on the budget resolution today. 

So we are still in the process we outlined in our issue brief, with the Senate action being essentially procedural but setting the stage for a reconciliation bill that will be used to repeal significant parts of the ACA. Congress appears to be at least several weeks away from voting on legislation repealing the law. And, despite Trump’s remarks this week that repeal and replace will be done simultaneously, signals from Congress (at least at this point) show how difficult that might be.

Republicans are being pushed on a faster timeline than they’d likely want to be—there is no clear replacement option that Republicans can agree on. President-Elect Trump has indicated that Rep. Tom Price will introduce a replacement plan as soon as he is confirmed as head of the Department of Health and Human Services. But without a plan that has broad consensus among the GOP, the ranks are showing divisions. Today’s vote in the House on the resolution might not be as straightforward as initially hoped, with some Republicans saying they want a simultaneous repeal and replace with a 2-year phase-out and others pushing for a longer phase-out of 3 or 4 years as House Speaker Paul Ryan plans to launch a concurrent repeal and replace “rescue mission for Americans from Obamacare.”

Because of the limitations around what can be accomplished through reconciliation, there is the potential for President-Elect Trump to use Executive Action to move some changes forward—adding another element of uncertainty to the repeal and replace story. One thing is certain: it ain’t over till it’s over; we expect to be writing about ACA repeal and replace for a long time to come.

To read a full and complete cheat sheet to the ACA repeal efforts, click here.

Health Policy Weekly is written by Xcenda, a consultancy and business unit of AmerisourceBergen Specialty Group. Visit Xcenda’s online archive to access more health policy news.

To subscribe to Health Policy Weekly click here.