2017 Affordable Care Act replacement proposals: Difference between revisions

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The following is a list of plans being considered in order to replace the Patient Protection and Affordable Care Act, as a result of the Republican Party's gains in the 2016 US elections. "Repeal and replace" has been a Republican slogan since March 2010 when Obamacare was signed into law and has been adopted by President Donald Trump.^[1]

Background

Donald Trump was sworn in as President of the United States on January 20th, 2017. President Trump and many Republicans have vowed to repeal and replace Obamacare; President Trump signed an executive order on January 20, 2017, his first day in office, that according to White House Press Secretary Sean Spicer would "ease the burden of Obamacare as we transition from repeal and replace". Spicer would not elaborate further when asked for more details.^[2]^[3]^[4]

On January 12, 2017, the Senate voted 51 to 48 to pass an FY2017 budget resolution, S.Con.Res. 3, that contained language allowing the repeal of the Affordable Care Act through the budget reconciliation process, which disallows a filibuster in the Senate.^[5]^[6]^[7]^[8]^[9] In spite of efforts during the vote-a-rama (a proceeding in which each amendment was considered and voted upon for about 10 minutes each until all 160 were completed) that continued into the early hours of the morning, Democrats could not prevent "the GOP from following through on its repeal plans."^[7]^[10]

Plans

Several media outlets have reported widespread opposition in Congress and the American public against repealing the Affordable Care Act without replacing it. Barack Obama has stated that “The Republicans will own the problems with the health care system if they choose to repeal something that is providing health insurance to a lot of people”.^[11]

Early proposals

According to obamacarefacts.com, a website supportive of the Affordable Care Act, the proposed CARE Act reverts many of the benefits of the Affordable Care Act.^[12]

Senator Rand Paul has said he plans to introduce a replacement plan during the week of January 9th, 2017.^[13] One key provision in his coming plan is to offer cheaper, less robust insurance plans for people.^[14]

Senators Susan Collins (Maine) and Bill Cassidy (La.) have announced a plan, The Patient Freedom Act of 2017, to be introduced Monday, January 23rd, 2017, which would offer states the option to retain the Affordable Care Act, if they chose, or receive a block grant to be used on an alternative plan they prefer.^[15]^[16]

House legislation

American Health Care Act

A comprehensive plan to replace the Affordable Care Act was announced by the House Republican leadership on March 6, 2017. It retains many features of the Affordable Care Act, but replaces ACT's system of subsidies with tax credits and federally-funded Medicaid coverage with a system of block grants to states based on the nature and number of recipients served. Conservative critics such as Rand Paul characterized the plan as "Obamacare Light" and continued to advocate total repeal, while other Republicans such as Cory Gardner from states which had accepted Medicaid expansion expressed worry about whether the new plan would adequately fund services for Medicaid patients.^[17]

The United States House Committee on Ways and Means approved one portion of the bill on March 9, 2017 after an all-night session.^[18] The second portion of the bill was also approved March 9 by the United States House Committee on Energy and Commerce on a party-line vote.^[19] On March 13 the Congressional Budget Office released its evaluation of the proposal. It projected a rise in uninsured by 24 million by 2028, but savings of $337 billion over ten years.^[20]^[21] By 2016 the CBO estimates that the average amount paid for medical insurance would decrease by about 10%. That results from increased prices for older patients and reduced credits which is predicted to increase the proportion of younger people in the pool and reduce the proportion of older people.^[22]^[23] The bill was approved by the House Budget Committee 19 to 17 on March 16, 2017. Three members of the Freedom Caucus, Dave Brat (Va.), Mark Sanford (S.C.) and Gary Palmer (Ala.) voted against it.^[24] It goes next to the House Rules Committee,^[24] then to the full House.^[18] The bill, if it passes the House, will go to the Senate under budget reconciliation rules. Thus, only material which affects the budget can be included and only a simple majority vote will be required in the Senate. Despite his vow not to get involved into day-to-day politics former President Obama became a part of it on March 23, 2017 by hailing among other things 20 million more people insured, preexisting conditions covered, young people staying on their parents' plans until 26, lowered costs for women's health care and free preventive care as progress due the Affordable Care Act.^[25]^[26] On March 24, 2017, the Bill was withdrawn by Speaker Paul Ryan (with the endorsement of President Donald Trump) after failing to gain enough support in the House of Representatives. ^[27]

Other legislation

On March 7, 2017 Pete Sessions sponsored an alternate proposal to repeal and replace the Patient Protection and Affordable Care Act entitled the "World's Greatest Healthcare Plan of 2017".^[28] The bill's current format removes the ACA's individual mandate, which taxed individuals without health insurance. Moreover, it maintains some aspects of the ACA including ensuring insurance coverage for pre-existing conditions, allowing children to stay on their parents' health care until they are 26 years old, and banning the use of lifetime spending limits by insurance companies.^[29]

References

^ Carl Hulse (January 15, 2017). "'Repeal and Replace': Words Still Hanging Over G.O.P.'s Health Care Strategy". The New York Times. Retrieved January 16, 2017.
^ http://www.cnn.com/2017/01/20/politics/inauguration-live-coverage/index.html
^ Luhby, Tami (2017-01-06). "Americans split over Trump's ability to fix health care". CNNMoney. Retrieved 2017-01-09.
^ Luhby, Tami (2017-01-09). "How Trump could use his executive power on Obamacare". CNNMoney. Retrieved 2017-01-09.
^ "S.Con.Res.3 – A concurrent resolution setting forth the congressional budget for the United States Government for fiscal year 2017 and setting forth the appropriate budgetary levels for fiscal years 2018 through 2026". United States Congress. 2017-01-03. Retrieved 2017-01-12.
^ Snell, Kelsey; DeBonis, Mike (2017-01-12). "Obamacare is one step closer to repeal after Senate advances budget resolution". Washington Post. Retrieved 2017-01-12.
^ ^a ^b Andrew Taylor (January 12, 2017), Congress presses ahead on dismantling health care law, St. Louis, MO: St. Louis Today, retrieved January 13, 2017 {{citation}}: Unknown parameter |agency= ignored (help)
^ 115th Congress (2017) (January 3, 2017). "S.Con.Res. 3 (115th)". Legislation. GovTrack.us. Retrieved January 13, 2017. A concurrent resolution setting forth the congressional budget for the United States Government for fiscal ...{{cite web}}: CS1 maint: numeric names: authors list (link)
^ Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act (PDF), Congressional Research Service, January 9, 2017, p. 23, retrieved January 13, 2017 {{citation}}: Cite uses deprecated parameter |authors= (help)
^ "Senate opens Obamacare repeal drive with overnight marathon". 12 January 2017. Retrieved 15 January 2017.
^ "Why the GOP Still Lacks an ACA Replacement Plan | RealClearPolitics". Retrieved 2017-01-10.
^ "ObamaCare Replacement Plan: "CARE" Act Facts - Obamacare Facts". Obamacare Facts. Retrieved 2017-01-10.
^ Carney, Jordain (2017-01-09). "Rand Paul rolling out ObamaCare replacement this week". TheHill. Retrieved 2017-01-10.
^ CNN, Gregory Krieg. "Rand Paul previews Obamacare replacement plan". CNN. Retrieved 2017-01-16. {{cite web}}: |last= has generic name (help)
^ Jordain Carney (January 17, 2017). "GOP senators introducing ObamaCare replacement Monday". The Hill. Retrieved January 18, 2017.
^ "Senators Collins, Cassidy to Introduce ACA Replacement Plan to Expand Choices, Lower Health Care Costs" (press release). collins.senate.gov. Senator Susan Collins. January 17, 2017. Retrieved January 18, 2017.
^ Robert Pear and Thomas Kaplan (March 6, 2017). "House Republicans Unveil Plan to Replace Health Law". The New York Times. Retrieved March 7, 2017.
^ ^a ^b Thomas Kaplan, Abby Goodnough and Jennifer Steinhauer (March 9, 2017). "Health Bill Clears House Panel in Pre-Dawn Hours". The New York Times. Retrieved March 9, 2017.
^ Jessie Hellmann (March 9, 2017). "Second committee advances ObamaCare repeal legislation". The Hill. Retrieved March 9, 2017.
^ Thomas Kaplan (March 13, 2017). "Health Bill Would Raise Uninsured by 24 Million but Save $337 Billion, Report Says". The New York Times. Retrieved March 13, 2017. The House Republican plan to repeal and replace the Affordable Care Act would raise the number of people without health insurance by 24 million within a decade, but would trim $337 billion from the federal deficit over that time, the nonpartisan Congressional Budget Office said on Monday.
^ Congressional Budget Office (March 13, 2017). "CONGRESSIONAL BUDGET OFFICE COST ESTIMATE" (PDF). Congressional Budget Office. Retrieved March 13, 2017. CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period. CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
^ Margot Sanger-Katz (March 14, 2017). "No Magic in How G.O.P. Plan Lowers Premiums: It Pushes Out Older People". The New York Time. Retrieved March 14, 2017. The C.B.O. estimates that the price an average 64-year-old earning $26,500 would need to pay after using a subsidy would increase from $1,700 under Obamacare to $14,600 under the Republican plan.
^ Peter Sullivan (March 14, 2017). "Five key findings from the CBO's healthcare score". The Hill. Retrieved March 14, 2017.
^ ^a ^b Jessie Hellman (March 16, 2017). "Budget panel advances ObamaCare bill with three GOP defections". The Hill. Retrieved March 16, 2017.
^ Taylor, Jessica (23 March 2017). "Obama: 'America Is Stronger Because Of The Affordable Care Act'". National Public Radio. Archived from the original on 31 March 2017. Retrieved 31 March 2017.
^ Teague Beckwith, Ryan (23 March 2017). "Read Barack Obama's Statement on the Anniversary of Obamacare". Time Magazine. Archived from the original on 31 March 2017. Retrieved 31 March 2017.
^ Daniella Diaz and Amanda Wills (March 24, 2017). "Trump and GOP pull health care bill". CNN. Retrieved March 24, 2017.
^ "H.R.1275 - World's Greatest Healthcare Plan of 2017". Congress.gov. Retrieved March 9, 2017. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
^ DeBonis, Mike; Costa, Robert; Weigel, David (March 7, 2017). "House GOP proposal to replace Obamacare sparks broad backlash". Washington Post. Retrieved March 9, 2017. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)

[NYT011517-1] Carl Hulse (January 15, 2017). "'Repeal and Replace': Words Still Hanging Over G.O.P.'s Health Care Strategy". The New York Times. Retrieved January 16, 2017.

[2] ttp://www.cnn.com/2017/01/20/politics/inauguration-live-coverage/index.html

[3] Luhby, Tami (2017-01-06). "Americans split over Trump's ability to fix health care". CNNMoney. Retrieved 2017-01-09.

[4] Luhby, Tami (2017-01-09). "How Trump could use his executive power on Obamacare". CNNMoney. Retrieved 2017-01-09.

[5] "S.Con.Res.3 – A concurrent resolution setting forth the congressional budget for the United States Government for fiscal year 2017 and setting forth the appropriate budgetary levels for fiscal years 2018 through 2026". United States Congress. 2017-01-03. Retrieved 2017-01-12.

[6] Snell, Kelsey; DeBonis, Mike (2017-01-12). "Obamacare is one step closer to repeal after Senate advances budget resolution". Washington Post. Retrieved 2017-01-12.

[stltoday-7] Andrew Taylor (January 12, 2017), Congress presses ahead on dismantling health care law, St. Louis, MO: St. Louis Today, retrieved January 13, 2017 {{citation}}: Unknown parameter |agency= ignored (help)

[8] 115th Congress (2017) (January 3, 2017). "S.Con.Res. 3 (115th)". Legislation. GovTrack.us. Retrieved January 13, 2017. A concurrent resolution setting forth the congressional budget for the United States Government for fiscal ...{{cite web}}: CS1 maint: numeric names: authors list (link)

[CRS_2017_repealACA-9] Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act (PDF), Congressional Research Service, January 9, 2017, p. 23, retrieved January 13, 2017 {{citation}}: Cite uses deprecated parameter |authors= (help)

[10] "Senate opens Obamacare repeal drive with overnight marathon". 12 January 2017. Retrieved 15 January 2017.

[11] "Why the GOP Still Lacks an ACA Replacement Plan | RealClearPolitics". Retrieved 2017-01-10.

[12] "ObamaCare Replacement Plan: "CARE" Act Facts - Obamacare Facts". Obamacare Facts. Retrieved 2017-01-10.

[13] Carney, Jordain (2017-01-09). "Rand Paul rolling out ObamaCare replacement this week". TheHill. Retrieved 2017-01-10.

[14] CNN, Gregory Krieg. "Rand Paul previews Obamacare replacement plan". CNN. Retrieved 2017-01-16. {{cite web}}: |last= has generic name (help)

[Hill011717-15] Jordain Carney (January 17, 2017). "GOP senators introducing ObamaCare replacement Monday". The Hill. Retrieved January 18, 2017.

[Collins011717-16] "Senators Collins, Cassidy to Introduce ACA Replacement Plan to Expand Choices, Lower Health Care Costs" (press release). collins.senate.gov. Senator Susan Collins. January 17, 2017. Retrieved January 18, 2017.

[NYT3617-17] Robert Pear and Thomas Kaplan (March 6, 2017). "House Republicans Unveil Plan to Replace Health Law". The New York Times. Retrieved March 7, 2017.

[NYT3917-18] Thomas Kaplan, Abby Goodnough and Jennifer Steinhauer (March 9, 2017). "Health Bill Clears House Panel in Pre-Dawn Hours". The New York Times. Retrieved March 9, 2017.

[Hill3917-19] Jessie Hellmann (March 9, 2017). "Second committee advances ObamaCare repeal legislation". The Hill. Retrieved March 9, 2017.

[NYT031317-20] Thomas Kaplan (March 13, 2017). "Health Bill Would Raise Uninsured by 24 Million but Save $337 Billion, Report Says". The New York Times. Retrieved March 13, 2017. The House Republican plan to repeal and replace the Affordable Care Act would raise the number of people without health insurance by 24 million within a decade, but would trim $337 billion from the federal deficit over that time, the nonpartisan Congressional Budget Office said on Monday.

[CBO031317-21] Congressional Budget Office (March 13, 2017). "CONGRESSIONAL BUDGET OFFICE COST ESTIMATE" (PDF). Congressional Budget Office. Retrieved March 13, 2017. CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period. CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

[NTY031417-22] Margot Sanger-Katz (March 14, 2017). "No Magic in How G.O.P. Plan Lowers Premiums: It Pushes Out Older People". The New York Time. Retrieved March 14, 2017. The C.B.O. estimates that the price an average 64-year-old earning $26,500 would need to pay after using a subsidy would increase from $1,700 under Obamacare to $14,600 under the Republican plan.

[Hill031417-23] Peter Sullivan (March 14, 2017). "Five key findings from the CBO's healthcare score". The Hill. Retrieved March 14, 2017.

[Hill031617-24] Jessie Hellman (March 16, 2017). "Budget panel advances ObamaCare bill with three GOP defections". The Hill. Retrieved March 16, 2017.

[25] Taylor, Jessica (23 March 2017). "Obama: 'America Is Stronger Because Of The Affordable Care Act'". National Public Radio. Archived from the original on 31 March 2017. Retrieved 31 March 2017.

[26] Teague Beckwith, Ryan (23 March 2017). "Read Barack Obama's Statement on the Anniversary of Obamacare". Time Magazine. Archived from the original on 31 March 2017. Retrieved 31 March 2017.

[Trump_and_GOP_pull_health_care_bill-27] Daniella Diaz and Amanda Wills (March 24, 2017). "Trump and GOP pull health care bill". CNN. Retrieved March 24, 2017.

[28] "H.R.1275 - World's Greatest Healthcare Plan of 2017". Congress.gov. Retrieved March 9, 2017. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)

[29] DeBonis, Mike; Costa, Robert; Weigel, David (March 7, 2017). "House GOP proposal to replace Obamacare sparks broad backlash". Washington Post. Retrieved March 9, 2017. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)

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 A comprehensive plan to replace the Affordable Care Act was announced by the House Republican leadership on March 6, 2017. It retains many features of the Affordable Care Act, but replaces ACT's system of subsidies with tax credits and federally-funded [[Medicaid]] coverage with a system of block grants to states based on the nature and number of recipients served. Conservative critics such as [[Rand Paul]] characterized the plan as "Obamacare Light" and continued to advocate total repeal, while other Republicans such as [[Cory Gardner]] from states which had accepted Medicaid expansion expressed worry about whether the new plan would adequately fund services for Medicaid patients.<ref name="NYT3617">{{cite news|url=https://www.nytimes.com/2017/03/06/us/politics/affordable-care-act-obamacare-health.html|title=House Republicans Unveil Plan to Replace Health Law|date=March 6, 2017|work=The New York Times|author1=Robert Pear and Thomas Kaplan|accessdate=March 7, 2017}}</ref>
 The [[United States House Committee on Ways and Means]] approved one portion of the bill on March 9, 2017 after an all-night session.<ref name="NYT3917">{{cite news|url=https://www.nytimes.com/2017/03/09/us/politics/health-bill-clears-house-panel-in-pre-dawn-hours.html|title=Health Bill Clears House Panel in Pre-Dawn Hours|date=March 9, 2017|work=The New York Times|author1=Thomas Kaplan, Abby Goodnough and Jennifer Steinhauer|accessdate=March 9, 2017}}</ref>  The second  portion of the bill was also approved March 9 by the [[United States House Committee on Energy and Commerce]] on a party-line vote.<ref name="Hill3917">{{cite news|author1=Jessie Hellmann|title=Second committee advances ObamaCare repeal legislation|url=http://thehill.com/homenews/house/323213-commerce-committee-advances-obamacare-repeal-legislation|accessdate=March 9, 2017|work=The Hill|date=March 9, 2017}}</ref> On March 13 the [[Congressional Budget Office]] released its evaluation of the proposal. It projected a rise in uninsured by 24 million by 2028, but savings of $337 billion over ten years.<ref name="NYT031317">{{cite news|author1=Thomas Kaplan|title=Health Bill Would Raise Uninsured by 24 Million but Save $337 Billion, Report Says|url=https://www.nytimes.com/2017/03/13/us/politics/affordable-care-act-health-congressional-budget-office.html|accessdate=March 13, 2017|work=The New York Times|date=March 13, 2017|quote=The House Republican plan to repeal and replace the Affordable Care Act would raise the number of people without health insurance by 24 million within a decade, but would trim $337 billion from the federal deficit over that time, the nonpartisan Congressional Budget Office said on Monday.}}</ref><ref name="CBO031317">{{cite web|author1=Congressional Budget Office|title=CONGRESSIONAL BUDGET OFFICE COST ESTIMATE|url=https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact_0.pdf|publisher=Congressional Budget Office|accessdate=March 13, 2017|format=PDF|date=March 13, 2017|quote=CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period. CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.}}</ref> By 2016 the CBO estimates that the average amount paid for medical insurance would decrease by about 10%. That results from increased prices for older patients and reduced credits which is predicted to increase the proportion of younger people in the pool and reduce the proportion of older people.<ref name="NTY031417">{{cite news|author1=Margot Sanger-Katz|title=No Magic in How G.O.P. Plan Lowers Premiums: It Pushes Out Older People|url=https://www.nytimes.com/2017/03/14/upshot/no-magic-in-how-gop-plan-lowers-premiums-it-penalizes-older-people.html|accessdate=March 14, 2017|work=The New York Time|date=March 14, 2017|quote=The C.B.O. estimates that the price an average 64-year-old earning $26,500 would need to pay after using a subsidy would increase from $1,700 under Obamacare to $14,600 under the Republican plan.}}</ref><ref name="Hill031417">{{cite news|author1=Peter Sullivan|title=Five key findings from the CBO's healthcare score|url=http://thehill.com/policy/healthcare/323897-five-key-findings-from-the-cbos-healthcare-score|accessdate=March 14, 2017|work=The Hill|date=March 14, 2017}}</ref> The bill was approved by the [[United States House Committee on the Budget|House Budget Committee]] 19 to 17 on March 16, 2017. Three members of the [[Freedom Caucus]], [[Dave Brat]] (Va.), [[Mark Sanford]] (S.C.) and [[Gary Palmer (politician)|Gary Palmer]] (Ala.) voted against it.<ref name="Hill031617">{{cite news|author1=Jessie Hellman|title=Budget panel advances ObamaCare bill with three GOP defections|url=http://thehill.com/policy/healthcare/324280-budget-committee-advances-gops-obamacare-repeal-bill|accessdate=March 16, 2017|work=The Hill|date=March 16, 2017}}</ref> It goes next to the [[United States House Committee on Rules|House Rules Committee]],<ref name="Hill031617"/> then to the full House.<ref name="NYT3917"/> The bill, if it passes the House, will go to the Senate under [[Reconciliation (United States Congress)|budget reconciliation rules]]. Thus, only material which affects the budget can be included and only a simple majority vote will be required in the Senate.
-On March 24, 2017, the Bill was withdrawn by Speaker [[Paul Ryan]] (with the endorsement of [[President Donald Trump]]) after failing to gain enough support in the [[United States House of Representatives|House of Representatives.]] <ref name="Trump and GOP pull health care bill">{{cite news|author1=Daniella Diaz and Amanda Wills|title=Trump and GOP pull health care bill|url=http://edition.cnn.com/2017/03/23/politics/trump-health-care-latest/index.html|accessdate=March 24, 2017|work=CNN|date=March 24, 2017}}</ref>
+Despite his vow not to get involved into day-to-day politics former President Obama became a part of it on March 23, 2017 by hailing among other things 20 million more people insured, preexisting conditions covered, young people staying on their parents' plans until 26, lowered costs for women's health care and free preventive care as progress due the Affordable Care Act.<ref>{{cite news|last1=Taylor|first1=Jessica|title=Obama: 'America Is Stronger Because Of The Affordable Care Act'|url=http://www.npr.org/2017/03/23/521259581/obama-america-is-stronger-because-of-the-affordable-care-act|accessdate=31 March 2017|publisher=National Public Radio|date=23 March 2017|archiveurl=https://web.archive.org/web/20170331203727/http://www.npr.org/2017/03/23/521259581/obama-america-is-stronger-because-of-the-affordable-care-act|archivedate=31 March 2017}}</ref><ref>{{cite news|last1=Teague Beckwith|first1=Ryan|title=Read Barack Obama's Statement on the Anniversary of Obamacare|url=http://time.com/4710841/obamacare-repeal-barack-obama-statement/|accessdate=31 March 2017|publisher=Time Magazine|date=23 March 2017|archiveurl=https://web.archive.org/web/20170331204859/http://time.com/4710841/obamacare-repeal-barack-obama-statement/|archivedate=31 March 2017}}</ref> On March 24, 2017, the Bill was withdrawn by Speaker [[Paul Ryan]] (with the endorsement of [[President Donald Trump]]) after failing to gain enough support in the [[United States House of Representatives|House of Representatives.]] <ref name="Trump and GOP pull health care bill">{{cite news|author1=Daniella Diaz and Amanda Wills|title=Trump and GOP pull health care bill|url=http://edition.cnn.com/2017/03/23/politics/trump-health-care-latest/index.html|accessdate=March 24, 2017|work=CNN|date=March 24, 2017}}</ref>
 ====Other legislation====