Immediate or gradual? GOP divided on best approach to dismantle ACA

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Republican lawmakers are divided over whether to immediately repeal the ACA or change it gradually.

As calls to repeal the Affordable Care Act have intensified following Donald Trump’s presidential victory, a divide appears to be widening among Republican lawmakers who want an immediate repeal of the law and those advocating for more gradual changes.

Some, like Sen. John Barrasso (R-Wyo.), are advocating for abrupt changes from a Trump-appointed secretary of Health and Human Services, according to Reuters. After being confirmed on Jan. 20, the HHS appointee could instantly gut provisions of the law by approving state waivers and abolishing mandates for individuals and employers.

An immediate, full repeal of the ACA is unlikely given the short-term impact on insured Americans and the procedural difficulties of pushing repeal through the Senate. However, “a new secretary of HHS going after the regulations can be a 'Day One' activity," Barrasso told Reuters.

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The Trump administration could also pull funding for insurance subsidies, effectively undoing the ACA marketplaces, Politico reports. While some legislators are in favor of that immediate approach, others are advocating a more measured tactic that would include a viable replacement. Some are advocating for the revival of a 2015 repeal bill that President Barack Obama vetoed at the beginning of the year.

Rep. Phil Roe (R-Tenn.) told Politico that Americans are already purchasing health coverage through the exchanges for 2017, and there should be a transition plan for those that have ACA health plans.

“There’s nothing you can do about that,” Roe told the news outlet. “It’s going to take one to two years to reconstitute a marketplace.”  

Republicans have openly resisted the ACA from the moment it became law, mounting various repeal attempts and legal challenges over the last six years. Although many are eager to dismantle the law entirely, others are wary of the political implications of rolling back insurance coverage gains.

Adding to existing rifts within the party, Trump recently indicated that he would like to preserve parts of the ACA, including the ban on denying coverage for those with preexisting conditions and a provision that allows young adults to stay on a parent’s plan until 26.

In his first postelection press conference on Monday, Obama called Trump “pragmatic” and urged him to weigh the impact of a full ACA repeal along with any potential alterations to the law.

“My view is if they can come up with something better that actually works and in a year or two after they’ve replaced the Affordable Care Act with their own plan, that 25 million people have health insurance and it’s cheaper and better and running smoothly, I’ll be the first one to say, ‘That’s great. Congratulations,” he said, but added that if millions of people end up losing coverage, “we’re going to have a problem.”

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