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Repealing the ACA under Trump


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President-elect Trump willing to keep parts of ObamaCare

President-elect Donald Trump said that, after conferring with President Barack Obama, he would consider leaving in place certain parts of the Affordable Care Act, an indication of possible compromise after a campaign in which he pledged repeatedly to repeal the 2010 health law.

In his first interview since his election earlier this week, Mr. Trump said one priority was moving “quickly” on the president’s signature health initiative, which he argued has become so unworkable and expensive that “you can’t use it.”

Yet, Mr. Trump also showed a willingness to preserve at least two provisions of the health law after the president asked him to reconsider repealing it during their meeting at the White House on Thursday

Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.

“I like those very much,” Mr. Trump said in the interview.

 

 

 

This is sounding less like a repeal and more like a tweak. Which is what everyone except Barack Obama has been saying for a while now.

 

I wonder how the base will react if it isn't, in fact, repealed? Since that's been the mantra and the goal of the 50+ attempts to repeal it since its inception.

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But you can't just repeal it without bad consequences.

Look at the Republican platform. Look at the Trump campaign promises. Look at who controls both chamber of Congress and soon to be all three branches of the federal government, as well as a heady majority of state legislatures in the country.

 

I'm afraid I can't see how "just repeal it" is not the path forward right now.

 

I'd be thankful for anyone who can spell this out to me.

Sorry If this has already been asked, but can it be repealed without a super majority in the Senate?

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I'm okay with the Republicans trying to improve or replace ACA, although I'd have to see their plan.

 

But I wonder what they'll do about women's health. A line I remember clearly from Jeb Bush was that he doesn't know if we need to be spending half a billion $ on women's health care.

 

You know... even though it's women who have babies - for two people, and take birth control - for two people

 

There's that other detail that we spend 600 billion on military. 600 billion on military but 500 million is too much to spend on child bearers.

 

The goal should be to make women less likely to choose abortion, by giving more support for having their baby.

Very good post!

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^I'm glad you think so, too! :D

 

Without a supermajority, the Democrats retain filibuster power. However, it can be undermined to smithereens anyway. As far as I can see, it's really at the President's -- and Congress's -- discretion.

 

The optimist in me thinks that Trump will smell a branding opportunity, pass single-payer, and call it TrumpCare. He'd have to fight Paul Ryan on that, but on this regard, Ryan is the true believer.

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I feel like the GOP would be OK with it if they could be the ones to say they fixed it and claim it as their own. Which is kind of ridiculous given the screams for blood every time the ACA is brought up. But if it brings along a more sustainable healthcare system, I'm all for it.

Again, agree completely with you. I've never felt the GOP was truly against all of Obama's policies. They just said no because they were coming from a Democrat.

 

Sad thing is if the Democrats try to work with the Republicans in the House/Senate, they will never get credit for it.

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^I'm glad you think so, too! :D

 

Without a supermajority, the Democrats retain filibuster power. However, it can be undermined to smithereens anyway. As far as I can see, it's really at the President's -- and Congress's -- discretion.

 

The optimist in me thinks that Trump will smell a branding opportunity, pass single-payer, and call it TrumpCare. He'd have to fight Paul Ryan on that, but on this regard, Ryan is the true believer.

Thanks. I'm not unreasonable, I want this country fixed. I hope The Donald can do it, but I'm very cautious.

 

I agree with Dudeguy's last post, too.

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Let's not spin off into that realm about how unethical Trump is in this thread. There are about 10 others people can do that in. Let's keep this one about the topic at hand please.

 

I like that he's showing just in a few days here he's open to listening and working with folks to try and get the healthcare part right. I know some folks that are dealing with these increases and it's not easy and we have to get this under control.

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After meeting with Obama, Trump has signaled his willingness to keep two parts of the ACA that he likes very much. What does that mean?

 

Trump's about to find out.

 

So how do you prevent that kind of gaming of the system by consumers? Well, that’s easy. You require that everyone buy at least some minimal level of insurance at the beginning of every year, so they can’t buy insurance only after they get sick. Let’s call that an” individual mandate.”

I think this presents a great (if fragile) opportunity for the Republican establishment to find out just how much Americans really want to lose the ACA.

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  • 2 weeks later...

What may happen if you repeal without replacing

 

 

Republicans say they plan to repeal Obamacare through reconciliation, a budget process that requires just 51 Senate votes and guarantees that Democrats can't stand in the way. But the GOP can't eliminate the entire law through reconciliation — just the parts tied to federal funding.

 

So lawmakers could nix the law's mandate requiring most Americans to buy insurance and the subsidies to help them afford it, but likely couldn't toss the ban on discriminating against people with pre-existing conditions — a policy that Republicans, including Trump, have talked about keeping in some form.

That could leave behind an unworkable coverage system in which insurers must cover everyone regardless of medical condition, while two key policies meant to attract healthier customers — the mandate and subsidies — are eliminated. And insurers would have no guarantee that Congress would come up with a viable replacement.

Iowa Insurance Commissioner Nick Gerhart, a Republican appointee, cautioned last week against repealing the law without a replacement, writing that it would have "devastating consequences in the disruption to people's care."

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Insurers could flee the marketplaces even sooner if Republicans strip away funding for the cost-sharing subsidies insurers provide to low-income customers. House Republicans successfully challenged the legality of that federal spending in court, but the Obama administration is appealing the ruling. Trump could drop that federal appeal on his first day in office, which would mean insurers still have to provide the subsidies but without federal funding. But because of a clause in their exchange contracts, insurers could immediately cut off coverage if the federal government no longer provided cost-sharing subsidies.

States might still be able to compel or persuade insurers to stay in the market for a short period.

 

I think this article presumes that "getting rid of the lines around the states" is not a viable future for our insurance system. I hope they're working on something very real right now, because slapping together generic conservative ideas for insurance is not going to cut it as a replacement for what we have now.

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I'm not very knowledgeable about the specifics of healthcare, but if, as some of you have said, the industry costs ballooning out of control is the real issue, then wouldn't heavy regulation of the industry be the answer?

 

I know that one of the objectives of the Trump presidency (and a conservative objective) is DE-regulation in general. However, hasn't a gradual increase in deregulation throughout the 80's and 90's put us in the position we are in right now? With large corporate interests served, and the income-gap widening.

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I mean, the correct answer is probably... :dunno

 

Everyone has a different approach they think is best. A lot of it depends on your goals. If you strictly want to get lower premiums, taking away the ACA would likely do so. I personally very much doubt turning things over to the private sector and the insurance companies themselves will fix the long-term health of the system. Insurance premiums were already going up before the ACA.

 

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The thing about simply tearing up the ACA and going back to the old way is that that neither helps everyone get coverage or ensures quality. If you're not a fan of pushing for universal coverage, the former point is probably fine with you. But if we push massive deregulation in the name of competition, you're going to remove a lot of safeguards that were put in place to ensure the quality of our coverage. I worry about a race to the bottom where we get cheaper and cheaper plans that offer increasingly poor coverage. Now, a good deregulation advocate would say that people would have the ability to find the level of coverage they want and pay for that. People could get crappy plans with very cheap premiums or pony up the dough for good plans with very expensive premiums.

 

Call me naive, but I'm not convinced the deregulated free market would offer good comprehensive coverage for those who need it most. Those who need the most medical care and thus more comprehensive coverage often have less access to resource they need to afford it-- I'm talking about the elderly and lower socioeconomic folks with poor health. Speaking of the elderly, Trump is apparently adopting Paul Ryan's plan for Medicare phaseout after explicitly campaigning on not changing Medicare-- another broken campaign promise:

 

http://talkingpointsmemo.com/edblog/trump-comes-out-for-medicare-phaseout

 

 

Rambling, I know. But I tend to agree more regulation is needed. The majority of countries that have achieved universal coverage have done so with at least some form of government support, be it single-payer, a multi-payer system like France where you government provides basic healthcare and you can purchase better supplemental plans if you so choose, or a mandate like we have here where we require folks to attain coverage or face a fine.

 

Tearing up ACA without a viable alternative accomplishes none of these. In short, I'm afraid the path they're on now will take coverage away from those who need it most and degrade coverage quality in the name of driving down prices for those who can afford it.

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  • 1 month later...

While You Were Sleeping, Senators Took the First Step Toward Obamacare Repeal

 

The Senate took a meaningful step toward repealing Obamacare in the early hours of Thursday morning, with Republicans voting nearly unanimously to approve a budget that would kill the health-care law. Going into the session, there was a sense that Democrats might be able to use the vote — and their freedom to offer politically dangerous amendments — to split the GOP over when and how they hoped to enact the repeal. After all, several Republican senators have lately voiced doubts over the party’s apparent strategy of repeal and delay, and the turmoil has only been deepened by Donald Trump’s recent announcements that Obamacare repeal must be accompanied by a full replacement with some yet-to-be-determined-but-definitely-terrific GOP plan. The logistics of doing what the president-elect and the handful of wavering Republican senators want are, to say the least, daunting.

 

But when it came to cast the key vote last night, party unity held: 51 of 52 Senate Republicans voted for the repeal budget (only Rand Paul bucked party discipline, reflecting his opposition to repealing Obamacare without a replacement plan being in place). No Democrats crossed the line to vote for it, though Dianne Feinstein was absent following surgery.

Over the course of the evening, 17 amendments were brought to the floor. Most were offered by Democrats, seeking to highlight popular aspects of Obamacare that would be lost in repeal. All the amendments were, in turn, defeated. The Republicans senators who were expected to offer an amendment to put off the deadline for passing the actual repeal — in the form of a budget-reconciliation bill — from late January to early March announced they were backing off, based on assurances from leadership that the deadlines could be adjusted later. Which is to say, for the moment, the party managed to paper over substantive disagreements by kicking key questions down the road.

So did Democrats get anything of value from this truncated exercise? Perhaps so. Republican senators are now on record as having rejected opportunities to keep Medicare, Medicaid, and the children’s health program CHIP off the cutting-room floor; to make it possible to import prescription drugs from Canada; to prevent erosion of women’s health services and support for rural hospitals; and perhaps most tellingly, to protect Medicaid funding for the 32 states that accepted the option of expanding that program under the Affordable Care Act.

Now it gets kicked to the House. The article mentions it's getting passed there unless the Freedom Caucus rebels wanting immediate replacement before repeal. Doubt it.
It should be noted that Democrats proposed a ton of amendments trying to protect different programs and ideas that would provide better care for people and were denied.
The GOP will sink or swim on their own with whatever they come up with.
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The country will wake up one day from this Republican bender with one hell of a hangover.

 

The problem is, the Democrats aren't exactly inspiring with their plans for the country, either. We so, so desperately need an unaffiliated leader to emerge who isn't beholden to either of these archaic parties.

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