It’s been more than seven years since the enactment of the Patient Protection and Affordable Care Act (ACA) and there were some 60 plus attempts to repeal by Republicans during the Obama administration. In fact, in early 2016, the House was able to easily pass a repeal bill (240 to 181), but, of course, Obama vetoed it. Now, in 2017, with Trump being President, one would think that with a Republican controlled House, Senate and now the White House, a repeal of the ACA would have been inevitable.
That’s not what happened. Instead, last Friday, the American Healthcare Act (AHCA) bill, which would have repealed much of the ACA, imploded. The Republican-drafted bill, led by House Speaker Paul Ryan, was pulled from a vote because there were insufficient votes among the House despite the large majority of Republicans. Indeed, the AHCA was pulled from a vote in the face of President Trump’s ultimatum: vote on the AHCA or move on. They are moving on.
In a press conference on Friday, along with the announcement that the AHCA would be pulled from a vote, Ryan acknowledged that the ACA would remain the “law of the land” for “the foreseeable future.” In the words of Sean Spicer, White House Press Secretary, there is no plan B.
Given the political rhetoric from Republicans about the ACA being a “disaster” and ready to “implode,” why move on? Why not come up with a plan B? More conservative Republicans, like the sizable House Freedom Caucus, can’t stomach any replacement bill that contains tax credits, which they dub as “entitlements” or “Obamacare lite” or “Obamacare 2.0,” or calls for the continuation of Medicaid expansion, and refuse to support any replacement that includes either of these.
The more moderate, “Tuesday Group” of Republican House members, like many Republican governors, show great concern about losing Medicaid expansion. So, any bill that satisfies the conservative Republicans won’t satisfy the moderate Republicans, and vice versa. This problem is even more acute in the Senate, where the Republicans hold only a slim majority.
The once seemingly obvious alternative of an outright repeal of the ACA faltered quickly after Trump took office. This was likely due to a change in circumstances. With seven years under its belt, there can be no dispute that the ACA has made a significant positive impact on some voters, including Republicans. This was through Medicaid expansion, premium tax credits to help offset monthly premiums, a ban on denial of coverage for preexisting conditions, among other features of the ACA. If the ACA had been repealed outright, at a minimum, those with healthcare coverage through Medicaid would lose it, those who received premium tax credits would lose them, and those with preexisting conditions would pay more for coverage. You’d be taking away real benefits from voters.
Earlier this year, when an ACA repeal showed up on the horizon, Republicans began facing mounting pressure to find a replacement from the press showing pro-ACA rallies nationwide to constituents who flooded them with calls to save their healthcare or who excoriated them during town halls if they managed to show (and some didn’t). The increasingly more pro-ACA sentiment left Republican lawmakers finding a repeal without a replace to be political suicide.
So, what could be a plan B? Working with Democrats to fix the problems with the ACA instead of chucking it could be a possibility. Recent events have shown that Trump can’t move forward with the Republican Congress. Trump’s approval ratings are at historic lows, and he needs a win desperately. Senate Minority Leader Chuck Schumer implied he would be willing to work with Trump on improving the ACA as long as repealing it was off the table.
However, given the polarization of healthcare since the ACA’s enactment and Trump’s own hostile rhetoric against the ACA, the likelihood of Trump working out a plan to fix the ACA is a pipe dream.
