Here we go again. President Donald Trump and House Speaker Paul Ryan (R-Wis.) say their proposals for repealing and “replacing” the Affordable Care Act will be ready really, really soon. Next month, in fact.
And they swear this won’t be like the other million times Republicans have made the same promise and failed to follow through.
Trump and Ryan made their comments at separate news conferences on Thursday, a few hours apart. Ryan’s came after a closed-door House meeting in which he and his lieutenants presented the broad brushstrokes ― again ― of what they are calling a “repeal plus” strategy.
Under this plan, they would first pass a bill stripping out the law’s funding and putting some elements of their replacement plan in place. Legislation to repeal the rest of the law and fill out the replacement would come later. At some point. Whenever.
Rank-and-file House Republicans didn’t seem to get the memo. Here’s Politico on lawmakers’ reaction to the presentation about the Affordable Care Act “replacement” on Thursday:
GOP leaders presented a menu of options for a health care alternative at the closed-door session, according to lawmakers in the room. But the lack of consensus was apparent as members left. In addition to questions over Medicaid, conservatives took issue with proposals to replace the health care law’s subsidies with tax credits to help consumers buy insurance. Many members also were lukewarm to ideas floated to fund a legislative package. ...
The continued discord seven weeks into the new Congress brought into high relief Republicans’ struggle to get on the same page to fulfill their most basic campaign pledge — a task that is turning out to be more complicated than they imagined.
There’s more of that in the Politico article, and it shows that Republicans have reckoned with few of the questions Congress and the White House need to answer in order to repeal the Affordable Care Act without completely blowing up the health care system. Apart from agreeing that “Obamacare” is a monstrosity, of course.
Congressional Republicans are so mixed up about what to do on health care that they can’t even agree on whether the Affordable Care Act’s Medicaid expansion ― which a number of GOP governors adopted in their states ― should go away, along with the rest of the law.
That’s right: There are Republicans who aren’t sure whether they want to get rid of a literal government-run entitlement program that redistributes wealth to the poor in the form of health coverage.
As America has plainly seen since Congress reconvened post-election, the GOP is finally facing down a reality it had the luxury to ignore when Barack Obama was president.
The Affordable Care Act provides health coverage to more than 20 million previously uninsured people. The law also changed expectations about what health insurance should do and who it’s for ― especially when it comes to guaranteeing access to coverage for people who have pre-existing conditions that would have locked them out of of the insurance market before the law.
Trump and Republicans in Congress have made noises about making sure no one loses coverage, except when they won’t guarantee that, or when they promise merely that people covered now won’t lose it right away, but at some future date instead.
They’re still stuck between their promises that health care after Obamacare will be “much less expensive and much better,” as Trump put it, and the reality that upending the Affordable Care Act inevitably will result in millions of people being worse off, while some unknown number of people might be better off.
Senate Majority Leader Mitch McConnell (R-Ky.) doesn’t seem to be doing anything at all on health care right now. And there’s a showdown in the making between conservatives in both chambers of Congress who want to burn Obamacare to the ground, never mind the consequences, and Senate Republicans who think maybe it’s not a great idea to smash the health care system with the largest available hammer until they have a notion of what they might build out of the wreckage.
But hey! Maybe this time they’ll pull it off. Maybe Trump’s White House ― not exactly making a reputation as a laboratory of innovative policy ideas ― and Ryan’s leadership team ― not exactly renowned for having its finger on the pulse of the GOP caucus ― is just a couple weeks from figuring out how to keep their promise to kill off that evil Obamacare without screwing anyone (or at least not anyone they care about).
Don’t bet the kids’ college fund on it, though.
Here’s what we do know: During Thursday’s meeting, House Republican leaders circulated a briefing paper outlining the GOP strategy for health care reform. It was basically the same as what Ryan and the leadership outlined over the summer with “A Better Way” proposal.
It calls for replacing the Affordable Care Act with a much weaker set of insurance regulations and tax credits that are based on age, rather than income. It also proposes phasing out the expansion of Medicaid, and then transforming the entire low-income health program by giving states more control and reducing federal funding.
Like the Better Way proposal, this new paper doesn’t include specifics, such as the value of those tax credits, or the actual formula for calculating Medicaid funds. Ryan, in his press conference, said his leadership team had submitted proposals to the Congressional Budget Office and Joint Committee on Taxation to evaluate how the proposals will affect insurance coverage and the budget.
That could mean Republicans have agreed on the numbers and aren’t making them public yet, or perhaps that they are close and just fine-tuning them.
It could also mean that, once again, Ryan is trying to create the illusion of progress, as he and other Republican leaders have been doing now for six years, 11 months and counting.
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