Republicans in Congress are now planning to wrap as many Affordable Care Act replacement elements as possible in legislation that would repeal the law.
Lawmakers are hoping to wrap four separate measures into a fast-track ACA repeal bill that needs only a simple majority to pass in the Senate, according to an article from Politico. The measures reflect ideas the GOP has already championed in its years of opposition to the ACA, including the expansion of health savings accounts and enacting high-risk insurance pools. They would also seek to reform Medicaid and create tax credits that make it easier to buy health plans.
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President Donald Trump said this week that an ACA replacement may not be ready until next year, but House Speaker Paul Ryan clarified that Congress still intends to finish replacement legislation in 2017, saying it's the implementation that can take longer. Industry groups have suggested a slower approach to the process, and Democrats have called on their counterparts to use caution.
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Separately, Republicans are also considering four bills that are designed to stabilize the ACA’s individual markets.
Another potential ACA replacement plan, from Rep. Mark Sanford, R-S.C., has caught the eye of the House of Representatives' Freedom Caucus, according to an article from The Hill. Similar to a bill introduced in the Senate by Rand Paul of Kentucky, it would end the individual mandate and would eliminate some of the ACA's protections for those with preexisting conditions. The caucus has yet to take a formal stance on the plan, though it is liked by its members, according to the article.
When replacing the ACA, the biggest piece of the puzzle will be reforms to Medicaid, according to Politico. Republicans are looking at establishing per capita caps that are tied to the number of enrollees in each state, according to the article, but that becomes a problem as they struggle to decide on whether allocations should be based on figures from before or after the ACA. Trump’s surrogates have also suggested that block grants for the program are on the table.
Another headache for the GOP is how to replace the healthcare law’s individual mandate, according to a second article from Politico. Options on the table would likely strip millions of their insurance or would go against core tenets of the party’s doctrine. And leaving people uninsured would not sit well with voters, especially as Trump has promised "insurance for everybody." Drafts of potential regulations from the Trump administration seeking to shore up the exchanges contained no language on the individual mandate.