Hospital Impact: GOP repeal, replace bill is dead on arrival

President Trump's first address to Congress emphasized infrastructure growth and national security, but what does that mean for hotels?
Kent Bottles gives his take on the Republican bill to repeal and replace the Affordable Care Act. Don't bother reading through it, he says, because "it will never become the law of the land because healthcare experts on the left and the right believe it simply will not work."


If you go about trying to please everyone, there's going to be endless struggles.                                    

 —Sonny Bill Williams


I also feel the need to please everyone, which is unnecessary and impossible.                                                           

 —Steve Nash

headshot of Kent Bottles

Trying to fulfill their promise to repeal and replace Obamacare, the House Republicans who crafted the recently released American Health Care Act (AHCA) did not learn the lessons sports superstars Williams and Nash learned from rugby and basketball. The bill tries to satisfy everyone but will end up not even satisfying enough Republicans to pass the House and the Senate.

I have read the entire bill. You can read it here, but I don’t recommend it as the bill is already dead on arrival. I conclude that it will never become the law of the land because healthcare experts on the left and the right believe it simply will not work. 

Let’s start with the policy wonks on the right who are harsh critics of the Affordable Care Act and would usually welcome a Republican alternative to healthcare reform:

  • Avik Roy of the Foundation for Research on Equal Opportunity states: "The critical mistake of the AHCA is its insistence on flat, non-means-tested tax credits. The flat credit will price many poor and vulnerable people out of the health insurance market."  
  • Robert Laszewski of the Health Care Policy and Marketplace Review concludes that the AHCA will not work because “Republicans are proposing an individual health insurance market scheme that may even be worse than Obamacare itself.”
  • Michael F. Cannon of the Cato Institute ends his analysis of the AHCA with “The House Republican leadership bill does not replace ObamaCare. It merely applies a new coat of paint to a building that Republicans themselves have already condemned.”  
  • Peter Suderman of Reason writes “it's not clear what constituency this bill is designed to satisfy, aside from Republican congressional leadership. It doesn't go far enough for conservatives, but may not be generous enough to appease more moderate Republicans either. (Democrats are, at this point, virtually certain to uniformly oppose the bill.)”

Healthcare policy experts on the left were more predictable in their uniform opposition to the AHCA:

  • Andy Slavitt, who served as the head of the Centers for Medicare & Medicaid Services under the Obama administration, in a series of tweets concludes that the AHCA is basically a tax cut ($600 billion) funded by gutting Medicaid that violates all of President Donald Trump’s stated commitments by covering fewer individuals, taking away protections, and increasing premiums and deductibles.
  • Loren Adler of the Schaeffer Initiative for Innovation in Health Policy predicts in a tweet that the AHCA will result in 15 to 20 million Americans losing their health insurance.
  • Ezra Klein of Vox writes the AHCA is “Republicans trying desperately to come up with something that would allow them to repeal and replace Obamacare. This is a compromise of a compromise of a compromise aimed at fulfilling that promise.”

Politically it may pass the House—although this is not certain—but it will not be able to garner enough votes in the Senate to become law.

Only three Republican Senators need to oppose the AHCA to make passage impossible, and this week Politico reported that four Republican Senators from red states that expanded Medicaid under the ACA stated they cannot support a law that guts Medicaid expansion. And The Hill reports that Sen. Rand Paul, R-Ky., and other more conservative legislators oppose the ACHA, which they call “Obamacare Lite” because it does not go far enough in the opposite direction to repeal the entire ACA.

If you want to get into the weeds like a true policy junkie, there are good summaries of the AHCA here, here, here and here.

The Republican leadership in the House is planning on voting on the AHCA before the Congressional Budget Office analyzes the bill to provide a prediction of how many Americans will lose healthcare insurance coverage and how much the bill will cost. Members who vote for a bill without knowing these details may find themselves in trouble come time for re-election. 

It is hard to see how a bill that is being criticized by healthcare experts of all stripes and alienates both conservative and moderate GOP senators will ever pass muster and become law. 


Kent Bottles, M.D., is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics.