The Obamacare repeal process seems very complicated. I’m hearing talk about a full repeal, “repeal and delay”, and something called “budget resolution”. While each of these represent different paths in the Obamacare repeal process, they all have the goal of getting rid of all the healthcare reform provisions that do not fit the Republican agenda.
We all know that the Republicans in Congress HATE Obamacare. They have spent the last six years trying to repeal it over 60 times! While President Obama was in office, the Republicans in Congress refused to work with the Democrats to make Obamacare better. In this Them against Us theater (called the Washington “swamp” by President-elect Trump), the needs of the individual American constituent are very much secondary. With majorities in both houses of Congress and the presidency, Republicans now have total control of the Obamacare repeal process… well almost. Our two-party system of government doesn’t let one party blindly enact political agendas that will do harm to the nation and its economy.
Since the November election, Republicans have been strategizing on how to best implement their Obamacare repeal process with optimum speed, minimum Democratic hindrance, and minimum political damage when Americans realize what they lost. While the Republicans would have loved to see Obamacare disappear immediately (full repeal), they have chosen to take a “back door” repeal route using what is called the budget reconciliation process. Let’s look at each route below.
Obamacare Repeal Process: Full Repeal and Delay
Let’s pretend for this discussion that we are Republican Senators intent on getting rid of the hated Obamacare (PPACA) NOW. We don’t care that the law contains hundreds of regulations and that some of them might even be not so bad, maybe even pretty good. We have a majority in both houses of Congress and the Presidency which means that whatever bills we create will become laws.
What is stopping us from throwing the whole Obamacare (PPACA) kit and caboodle into the trash immediately? One problem is that we do not have a Republican replacement that we can all agree upon and people will not be pleased if they lose the healthcare benefits they have had over the past three years. People jumped all over our “Repeal and Delay” concept as unworkable.
In addition, we have a simple majority (51 votes) but not a supermajority in the Senate (60 votes) and must therefore let those pesky Democrats filibuster the Obamacare-killing bills we create. DRAT and double DRAT! The filibuster (talking a long time) can’t kill a full repeal bill, but it can delay it from coming up for a vote indefinitely. If we (the majority) get sick of waiting for the filibuster to end, we will have to kill the bill and start over with another one. This process can tie up our efforts to repeal Obamacare for years and we should know.
During the Obama presidency, we used filibusters or the threat of them to obstruct major Democratic legislation 70% of the time! We made sure that various bills (and nominations) proposed by Democrats did not see the light. Now that the shoe is on the other foot, It stands to reason that the Democrats are itching to use the same tactic to stall Obamacare repeal. There must be a “back door” to repeal Obamacare that bypasses the Senate filibuster protection…
Obamacare Repeal Process: Budget Reconciliation
Budget reconciliation comes to the rescue. Budget reconciliation is an obscure maneuver to push legislation through by a simple majority. The process is complicated and has a lot of rules that limit what we can and cannot include in the budget reconciliation bill to repeal Obamacare. For example, there are rules that prohibit use of reconciliation for items that increase the budget deficit (called the Byrd rule). Because Obamacare contains federal budget-savings (through Medicare cost-cutting measures), we must leave them in place…at least for now.
Luckily we don’t have to start from scratch. Let’s bring out Representative (and soon-to-be Secretary of the Department of Health and Human Services (HHS)) Tom Price ‘s Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015. The bill would have (if President Obama hadn’t vetoed it) repealed Obamacare’s insurance subsidies, ended its Medicaid expansion, eliminated most of its taxes, and abolished the individual mandate. Tom Price kept out the Medicare cost-cutting measures because it would have run afoul of the Byrd rule and now that he will be the new Secretary of HHS, he can dismantle Medicare cost-cutting measures over time. Boy, are we glad many of the reforms in Obamacare (PPACA) were initiated “at the discretion of the Secretary”! We can’t touch non-budgetary provisions of Obamacare like banning discrimination against people with preexisting conditions, allowing people 26 and under to stay on their parents’ insurance, or banning annual/lifetime coverage limits. Those can also wait for later.
Obamacare Repeal Process– The President
President Trump has a few cards to play in the Obamacare repeal process that do not involve waiting for Congress to deliver the promised end to Obamacare (PPACA). One is called the executive order. Executive orders do not require congressional approval and therefore, the president can use them to set political agendas without public debate and opposition.
On January 20, 2017, the first day of his presidency, Donald Trump signed an executive order giving all federal agencies broad powers to unwind the “unwarranted economic and regulatory burden of the Act”. While this order cannot get rid of Obamacare (PPACA) by itself, it does give authority to all federal and state agencies to dismantle the administration that makes Obamacare function within government. For example, it tells the Internal Revenue Service (IRS) to stop collecting the penalties imposed on individual Americans (and businesses) who do not buy health insurance (or offer it to their employees) but can afford it. This effectively scraps Obamacare’s Individual Mandate and Employer Shared Responsibility Payment without the need for Congress to include it in any budget reconciliation bill.
People who buy insurance on the Health Insurance Marketplace are safe (hopefully) for at least one year since 2017 insurance contracts have already been set in legal contracts. Unfortunately, President Trump’s executive order gives the green flag to health insurance companies to withdraw from the Health Insurance Marketplace before the end of the year. While the consumers would keep their plans in 2017, they would no longer be eligible for the federal subsidies they need to be able to afford the insurance! Therefore, this executive order serves as a “back door” for the insurance companies to leave and a quicker Marketplace collapse.
The negative and disruptive impact of this one-page executive order on the lives of individual Americans screams silently.
Call To Action
As the Republicans rapidly move to erase all traces of Obamacare (PPACA) and forward their political agenda, the impact on the lives of individual Americans that will result from these actions are very much of secondary concern. It is important that individual Americans make clear to their elected officials that they will not stand for actions that TAKE AWAY healthcare benefits and affordability measures. Unraveling Obamacare (PPACA) is only HALF of the equation. Without the second half, namely, “better” healthcare benefits and affordability measures”, Americans end up worse off. Americans did not elect Donald Trump president so that he could fulfill some Republican political agenda.
Join BB’s Healthcare Brigade and let’s combine our voices in bringing Affordable Health Care and Beyond for ALL Americans.