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GOP Considers Four Obamacare Replacement Measures

“Repeal and replace” begins to jell

Republicans on Capitol Hill and within the Trump administration are considering four Obamacare replacement measures, with the goal of beginning work on the legislation in the relevant House committees by the end of February, according to a report from Politico. The emerging blueprint includes expanding health savings accounts; enacting high-risk health insurance pools; reforming Medicaid; and authorizing tax credits to help Americans buy insurance policies.

The replacement policies would be rolled into a measure that repeals the Patient Protection and Affordable Care Act (PPACA), which will be taken up and passed under an expedited process that requires only 51 votes for passage in the Senate. It’s unclear whether the Senate parliamentarian will allow the replacement pieces to be inserted into the bill, but if she signs off, the policies could provide reassurance to GOP lawmakers eager to vote on a replacement policy at the same time that the PPACA is scrapped, according to the article.

Vice President Mike Pence recently told House Republicans in a closed-door meeting that the administration is committed to repeal and that the bill can include much more policy than Republicans first thought.

The confirmation of Health and Human Services secretary designee Tom Price (R-Georgia)—expected to occur this week—could speed up the process as well. Price is expected to issue executive orders addressing aspects of the PPACA soon after he is sworn in.

Sources told Politico that the process is in its early stages and could still change. It’s unclear whether a repeal-and-replace bill would get enough support to pass—or how quickly. House Speaker Paul Ryan (R-Michigan) said at last month’s Republican retreat that the House will pass Obamacare repeal by March or April.

Medicaid is proving to be the most complex piece of a replacement plan in the repeal bill. Republicans want to overhaul the program by imposing spending caps tied to the number of enrollees in a state. But they are running into problems sorting out the details, such as whether funding should be allocated based on state enrollment before the PPACA or after.

Because Democrats would almost certainly oppose such a plan—known as “per capita caps”—Republicans need to attach it to a repeal bill, or they would have to recruit at least eight Senate Democratic votes to overcome an anticipated filibuster, according to Politico.

The refundable tax credits under consideration mirror the policy that House Republican leadership included in its “Better Way” agenda last year. Consumers would get a tax credit—adjusted for circumstances, such as family size—to help them buy insurance. The credits would replace PPACA subsidies used for the same purpose.

Source: Politico; February 8, 2017.

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