On the campaign trail, Donald Trump repeatedly said that if he was elected president, one of his first orders of business would be to “repeal and replace Obamacare” which he has described as a “disaster” for the American people as evidenced by skyrocketing premiums, unpopular individual and corporate mandates and health insurance companies abandoning the exchanges in droves. On Monday, March 6, 2017, seven years after The Affordable Care Act was introduced and just six weeks into President Trump’s administration, the long awaited Republican replacement The American Healthcare Act (AHCA) was unveiled by House Representatives Kevin Brady (R-Texas), chairman of the House Ways and Means Committee who coined the term “Obamacare Gone” and Greg Walden (R-Oregon), chairman of the House Energy Committee.
The AHCA has received a lukewarm reception from both the left and the right. Republican opponents refer to the plan as “Obamacare Lite” because it continues until 2020 the expansion of Medicaid, which ballooned under Obamacare. They also argue that the plan’s tax credits are extremely similar to the subsidies under Obamacare.
Republican organizations including the Freedom Caucus, Heritage Action, Club for Growth and Americans for Prosperity have professed their opposition to the AHCA. The tea party activist group FreedomWorks has announced that they will be implementing a six figure ad buy against the AHCA. FreedomWorks will also be hosting a Day of Action against the Obamacare replacement on Wednesday March 20 at Senate Park with 1000 activists. Participants will include Sen. Rand Paul (R-KY), who was the architect of a competing Obamacare replacement bill, Sen. Mike Lee (R-Utah) and Reps. Mark Sanford (R-S.C.), Louie Gohmert (R-Texas), Rep. Mark Meadows (R-N.C.), and Jim Jordan (R-Ohio).
Vice President Mike Pence and House Speaker Paul Ryan addressed congress in an effort to convert skeptical Republicans into accepting the plan. Both leaders appeared on the talk show circuit as well to promote the tenets of the AHCA to the American people. Vice President Pence also traveled to Louisville, KY to socialize the plan among various business groups and workers.
Democrats oppose the AHCA because they believe that the lower income individuals, including seniors, will spend more on healthcare with this plan than with the Affordable Care Act. AARP, the American Medical Association and the American Hospital Association have also issued public statements against the bill. According to the Kaiser Foundation, older low income individuals who live in states with higher premiums like Arizona would receive a greater subsidy under the ACA than the AHCA. Younger individuals with higher incomes who reside in states with lower premiums such as Massachusetts will receive higher tax credits under the AHCA versus the ACA, which may serve as an incentive for these individuals to sign up for healthcare.
AHCA achieved its first congressional hurdle on March 8, passing the House Ways and Means Committee 23-16. This vote took place at 4:30 am after the committee spent 18 hours deliberating the bill. The lengthy process was largely due to the fact that the Democrats insisted that the 123-page bill be read aloud. The AHCA was also approved on March 8 by the House Energy Committee 31-23 after 27 hours of deliberation. The next step is for the bill to go the House Budget Committee. It is expected to be scored next week. Then the AHCA goes to the full House for a vote before it is passed to the Senate where it is expected to face challenges which may ultimately result in the Senate Majority Leader Mitch McConnell exercising “the nuclear option” to garner the votes needed for approval.
It is important to remember that the AHCA is currently in its first phase. The second and third phases will include additional components including the possibility to buy insurance across state lines and reductions in drug pricing which will all help to lower overall costs. Furthermore, it has only been a few days since the bill has been introduced. It is certain to go through additional markups as it passes through the House before it even makes it to the Senate.
Said another way, we need to give the Obamacare repeal and replace process a chance.