Health Care

Is This Real? The Latest Threat to ACA

In the shadows, some Republicans continue to work on legislation that would repeal the Affordable Care Act, and devastate the American healthcare system. It’s clear that we will never be totally out of the woods on ACA repeal until we take back control in Congress. Until then, here is the latest on Republican efforts to leave millions more Americans uninsured.

What’s the latest development?

A summary of a recent version of ACA repeal has been circulating among conservative groups and lobbyists for a few weeks now. (You may have seen it on Twitter here.) And Lindsey Graham told The Hill newspaper that he was continuing to work on his legislation, following the collapse of “Graham-Cassidy” last fall. Former Senator Rick Santorum has been working with the White House to continue trying to sell this legislation, and has been seen on Capitol Hill recently for meetings with Republican senators. While it remains to be seen whether the political appetite exists to vote on such a bill, we remain vigilant and ready to forcefully respond.

This bill would be just as bad as other repeal efforts

It would eliminate Medicaid for millions of people . One of the key ways the Affordable Care Act so successfully increased the number of people with health care coverage was by expanding the groups of Americans that are eligible for Medicaid, covering 11 million more people. And, importantly, this expansion is paid almost entirely by the federal government—at 100 percent initially and then at 90 percent after 2020. This means that states can insure more of their residents without incurring many additional costs, and many states that once refused to adopt it are now doing so (like Virginia). Ending the Medicaid expansion hurts state economies and puts millions of people at risk of losing the coverage they need, including the elderly, the disabled, veterans, and people living with opioid abuse.

The bill replaces the Medicaid expansion with a “block grant” even more inadequate than the previous version of Graham-Cassidy. Republicans would slash and bundle all of the funding for the Medicaid expansion with the ACA’s tax credits that help people afford insurance, creating one lump sum for states. It would be redistributed to states unevenly, with states with key Republicans benefiting. And because Republicans have already made a downpayment on ACA repeal -- repealing the individual mandate through the GOP Tax Scam -- there is even less funding for this already inadequate block grant than the last time they tried to pass this.

The bill would give rich people another new tax break, because Republicans just can’t stop themselves. Under this bill, health savings accounts (HSAs) could be used for health insurance premiums, giving those who can afford it another way to shelter their income from being taxed. This may also incentivize employers to just put tax-free money into these HSAs and stop offering their staff employer-based health insurance all-together.

How real is this threat?

ACA repeal will be on the Republican legislative agenda until we reclaim power in at least one chamber of Congress. Republicans’ efforts to revive Graham-Cassidy represent a persistent threat simmering below the surface, but not an imminent threat at this time. Here’s why.

Republicans would have to use reconciliation again. That’s the special process in the Senate where legislation can pass with only 51 votes, instead of the usual 60 required to overcome a filibuster. The first step in reconciliation is passing a budget resolution that includes reconciliation “instructions” that would allow them to use reconciliation for repealing the ACA. There is currently little evidence to suggest that either the House or Senate is preparing to advance a budget resolution. In fact, many members don’t want to relitigate the budget numbers that would go into a budget resolution, especially in an election year. And since the budget deal that Congress passed in February covered two years, they don’t have to.

Mitch McConnell has other priorities. The Senate Majority Leader has recently threatened to cancel August recess, so that the Senate can focus exclusively on confirming Trump’s judicial nominees, passing appropriations bills that fund the government, and building Trump’s border wall. Moving first a budget resolution and then repeal legislation would seriously eat into floor time for those priorities. He’s also hinted publicly that he wants to avoid health care altogether because he thinks it could help Democrats in the midterm elections -- so much so that he has threatened to refuse to allow a vote on bipartisan opioid legislation.

Republicans are worse off in the Senate now than they were last fall. Since their last attempt at repealing ACA, Republican control of the Senate has slipped from 52-48 to 51-49 with the election of Senator Jones in Alabama. That means they have to hold their entire caucus together and win back some combination of Senators Collins (ME-R), Murkowski (AK-R), and McCain (AZ-R). Senator McCain is at home in Arizona for the foreseeable future, and Senators Collins and Murkowski have never supported any of the previous repeal efforts in this Congress. Senator Paul has also been steadfast in his opposition to Graham-Cassidy, so the unlikely scenario of winning over Collins and Murkowski doesn’t even guarantee Republicans a win.

Bottom line

Some Republicans are never going to give up on their ideological crusade to wreak havoc on people’s lives, and on our health care system, in service to their political goals. For now, it doesn’t appear that those Republicans bent on repealing the ACA have a path to victory. But we will stay vigilant, continue to monitor, and be the first to let you know if the environment changes. And if the threat becomes imminent, we’ll be ready.