Home E-Weekly May 9, 2017

Will the AHCA Trump the Affordable Care Act?

Published: May 8, 2017

REVISE AND REPLACE? The AHCA is likely to look very different by the time the Senate votes on it.

Will the American Health Care Act — the Republican effort to repeal and replace the Affordable Care Act — actually become law?

The controversial proposed alternative to Obamacare, which passed by a 217-213 vote in the House of Representatives last week, still faces an uphill battle. Senate Republicans, some of whom have already expressed concerns about the bill, will significantly alter it to try to garner the 51 votes they'll need to pass it, but with only 52 Republicans in the Senate, their position is precarious. If 3 or more of those 52 can't be coaxed to vote yes, the bill won't reach the President's desk.

Moreover, if the Senate sends a compromise bill back to the House, it may threaten the current bill's razor-thin majority support there. Any attempt to make the bill more palatable to moderate Republicans could alienate members of the so-called Freedom Caucus, a group of about 30 hardline House Republicans, whose support proved crucial after a first attempt failed in the House.

And unlike the House, which hurried the bill to a floor vote without waiting for the non-partisan Congressional Budget Office to "score" it, the Senate must wait for a CBO analysis before it can vote. In its original form, said the CBO, the AHCA would have increased the number of uninsured Americans by 24 million over the next 9 years. With only relatively minor changes, the new version of the bill is unlikely to dramatically reduce that number, and may actually increase it. That may make a yes vote harder for Senators to defend to constituents and other critics.

Additionally, some Republican Senators have already expressed concerns about other aspects of the bill. Alaska's Lisa Murkowski and Maine's Susan Collins, both Republicans, oppose efforts to block Planned Parenthood from receiving federal funding (Planned Parenthood doesn't get federal funding directly, but it is reimbursed when people on Medicaid use its services), and the AHCA bars federal funding for Planned Parenthood for a year.

Also, several Republican Senators represent states that have taken advantage of Obamacare's Medicaid expansion provision, the primary driver behind the large increase in the number of people who've gained insurance under Obamacare. Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Rob Portman of Ohio, in addition to Senator Murkowski, are known to be concerned that the new law, as written, would severely curtail Medicaid expansion.

The proposed law would also greatly weaken one of the most popular provisions of the ACA: the mandate that prevents insurers from denying coverage to people with preexisting conditions. Under the AHCA, insurance companies would be allowed to greatly increase premiums for such customers under certain conditions. The bill provides $8 billion over 5 years to help states deal with those higher rates, but critics say that amount would be woefully inadequate and many would be priced out of the insurance market.

Finally, several influential groups — including the American Medical Association and the American Association of Retired Persons (AARP) — have voiced strong opposition to the new legislation, adding to the pressure Republicans lawmakers will feel as they try to keep their years-long promise to repeal and replace the ACA. Now that they have the opportunity, they must weigh the potential political fallout of supporting a law that many observers insist will result in higher rates and/or reduced coverage for millions.

Jim Burger

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