With Republican lawmakers unable to reach a consensus on how to replace the Affordable Care Act, President Trump and some influential senators are now calling for a straightforward repeal of the law, with any replacement to come at some later date.
President Trump, as is his tendency, made his suggestion in an early morning Tweet, saying that if GOP senators can’t reach a deal on their current repeal-and-replace legislation, they should “immediately REPEAL, and then REPLACE at a later date!”:
Shortly after this remark, Sen. Rand Paul of Kentucky — who has decried the Senate bill as being “Obamacare Light” — claimed to have spoken to the President about this issue and that they are of a like mind about moving forward with simply repealing the 2010 healthcare law:
Nebraska’s Ben Sasse said this morning that he has written to the White House arguing for “maximum repeal, however much repeal we can do under these arcane reconciliation rules.”
In his letter, Sasse contends that it looks like his party “will either fail to pass any meaningful bill at all, or will instead pass a bill that looks to prop up many of the crumbling Obama care structures.”
The senator argues that if there is no way to get to 50 yes votes by July 10, “we should immediately vote again” on a 2015 repeal bill — introduced by Tom Price, the new Health and Human Services Secretary, when he was still in Congress. That bill made it all the way to President Obama’s desk before being vetoed in early 2016. The GOP did not have enough votes to overcome that veto.
What Would Repeal-Only Look Like?
If lawmakers were able to pass a clone version of that bill, what would that mean for Americans?
Among the key points of the vetoed Price legislation:
• Repealing the so-called “individual mandate” — the requirement that most people purchase some minimal form of qualifying healthcare coverage or face a financial penalty.
• Repealing the “employer mandate” — the requirement that larger employers provide qualifying coverage to their workers.
• Getting rid of subsidies for individual insurance policies purchased through state healthcare exchanges.
• Eliminating the 3.8% tax on investment earnings for individuals making at least $200,000 or married couples earning $250,000 combined.
• Eliminating the Prevention and Public Health Fund, which helps to pay for many state and local public health and disease prevention initiatives.
• Eliminating new taxes on medical devices manufacturers and insurers.
• Maintaining provisions that required insurers to let young adults stay on their parents’ insurance plans until age 26.
• Maintaining the prohibition against denying access or charging excessive premiums to Americans with pre-existing conditions.
A Dec. 2015 analysis of this bill by the Congressional Budget Office concluded that this legislation “would result in a less healthy population” in the individual insurance market, and “correspondingly higher average premiums.” The pain would be hardest felt in smaller states, where markets could become unstable “leading to very low to no participation by insurers and consumers.”
More recently, the CBO looked back at the Price legislation to estimate its impact on the number of Americans who would lose or go without coverage. According to that Jan. 2017 report, an additional 18 million people would likely lose or ditch their insurance within the first year of repeal. By 2026, that number would swell to 32 million — that’s 10 million more than the latest prediction for the current replacement bill being considered by the Senate.
Could A Straight Repeal Pass?
Anything is possible, and there are reportedly other hardline conservative senators who would line up to support a second chance at passing the Price bill. At the same time, with only a two-vote majority in the Senate, any bill would need strong backing by its more moderate members.
When the Senate voted on the Price bill in 2015, two Republicans — Sen. Mark Kirk (IL) and Sen. Susan Collins of Maine — voted against the measure, with no Democrats crossing party lines to vote yes. Kirk is no longer in the Senate, but there are other moderates who may have trouble selling their constituents on a full repeal.
Remember that the 2015 legislation — one of many repeal bills introduced since 2010 — was passed by Congress knowing full well that it would be vetoed by the White House and that it likely didn’t have the votes to override that veto. In fact, the House vote to override fell far short of the two-thirds majority needed.
If the Senate did decide to move forward with a strict repeal-only plan, knowing this time that there’s a very good chance the President would sign it, if all GOP lawmakers would feel comfortable passing a legislation that could leave so many Americans without insurance.