Sunday, August 20, 2017

Repeal & Replace of Obamacare: Flat-Lined Once Again

By on August 6, 2017

Editor’s note: The following article originally appeared in the August 3 print edition of Caribbean Business.

SAN JUAN — Even with U.S. Vice President Mike Pence’s increasing participation, the U.S. Senate’s so-called “skinny repeal” of the Patient Protection & Affordable Care Act (known as ACA or Obamacare) has flat-lined and it is unclear how further attempts will fare.

The “skinny repeal” measure, formally titled the Health Care Freedom Act in the Senate, was expected to create a conference committee between the two houses of Congress, rather than produce the repeal of the ACA. The version of the bill was called the American Health Care Act.

This is the latest setback in the Republican campaign promise to repeal and replace Obamacare. While it is still the Trump administration’s first year in office, the previous Republican-controlled Congress had attempted various repeals, completely or partially, of the ACA.

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Some of those efforts focused on complete repeals of particular portions of the law, rather than trying to repeal bigger sections of the law. The topics of education and prevention, taxes, Planned Parenthood and Health Savings Accounts were all addressed in distinct bills. Even when it came to repeals of the individual or employer mandates, the repeals or amendments were handled in separate bills.

As for the replacement part of their legislation, Congress previously focused on picking which elements of the ACA would stay should a repeal measure get passed, rather than a formal proposal for a system to substitute the current one. Furthermore, resembling Congress’ repeal attempts, the elements that would survive were also addressed in separate bills.

Previous GOP effort

Another item to point out is that the proposals that have been in the spotlight, with some exceptions including part of the Health Care Freedom Act, look for a more vigorous attempt to repeal Obamacare. On the other hand, bills for full and partial repeals of the ACA during the Obama administration sought more immediate implementation. This was the case with full repeal attempts by former House Majority Leader Eric Cantor, former Rep. Michele Bachmann and Sen. Ted Cruz.

Consistent with their message, the most common issues Congress previously attempted to change in the Affordable Care Act were the Health Savings Accounts and its tax provisions. Republicans, long proponents of enhancing these tax-exempt accounts, tried to lift the caps imposed by the ACA as well as increase uses for the accounts. When it came to tax policies and Obamacare, Senate Bill 983 of 2013, also known as the Keep the IRS Off Your Health Care Act, and House Resolution 2927 of the same year, known as No Taxation Without Verification Act, provided an idea about their views of ACA’s tax policies.

It appears the GOP has changed some strategies to address the end of the Affordable Care Act since its previous attempts. Moreover, with Senate Majority Leader Mitch McConnell taking weeks off for the August recess, the Senate could be preparing to once again fulfill their campaign promise. It is still unclear whether Republicans will return to smaller repeals of Obamacare, if they will focus on keeping Republican votes in line or the joint commission that was expected to be appointed after the failure of the “skinny repeal” will have a chance to produce a bipartisan proposal for a new healthcare system.

On the local front

In the mean time, Puerto Rico’s healthcare funding for its Mi Salud program for the medically indigent is running out. The island did not choose to fully participate in the ACA but instead received a block grant of $6.4 billion, which is expected to run out a year ahead of schedule. U.S. Health & Human Services Secretary Tom Price had argued that the island needed $900 million in additional funding to cover healthcare expenses this fiscal year.

However, the Puerto Rico government projected needing $600 million this fiscal year, of which the island is expected to receive $296.5 million. The other half of the funding was expected to be part of the allocation for the Children’s Health Insurance Program (CHIP), which is supposed to arrive in September. However, it remains to be seen if the back and forth in Congress will jeopardize procurements for the island.

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