Republicans finally possess their missing piece to repealing Obamacare: the White House.
Donald Trump’s stunning victory on Tuesday handed Republicans their first realistic shot at repealing the Affordable Care Act, after six years of bludgeoning the healthcare law in Congress and on the campaign trail.
Now with a president belonging to their own party and majorities in both the House and the Senate, Republican lawmakers could feasibly ditch major parts of the healthcare law next year and enact their own version of healthcare reform.
If Republicans and President-elect Trump move as quickly as they have promised, they would repeal the biggest parts of the healthcare law in the midst of its fourth enrollment season, potentially disrupting coverage for millions of Americans using the new insurance marketplaces.
Republicans still don’t have 60 votes in the Senate, so to repeal big parts of the law, they would have to use a process called budget reconciliation, which requires a simple majority to pass. That process could be used to eliminate parts of the law that affect federal spending, including its marketplaces, Medicaid expansion and mandates to buy coverage.
They have already laid the groundwork for that approach, using budget rules to pass a reconciliation bill in January. While President Obama vetoed that bill, Republicans now have a ready-made piece of legislation they could pass shortly after he’s inaugurated in January.
House Speaker Paul Ryan is ready to work with Trump on repealing and replacing the healthcare law, a Ryan spokeswoman told the Washington Examiner last week.
“Speaker Ryan is absolutely prepared to work with a Republican president on repealing and replacing Obamacare,” spokeswoman AshLee Strong said. “House Republicans have proposed a bold, patient-centered health care plan that would actually lower costs for Americans.”
Efforts to repeal the law likely would meet with some opposition from the healthcare industry, which generally supported the Affordable Care Act and worked closely with the Obama administration on implementing it.
The insurers’ trade group, America’s Health Insurance Plans, didn’t comment late Tuesday on the election results. But it did issue a statement saying it’s ready to work with the new administration on “solutions” for the marketplaces, which have been plagued by spiking premiums and reduced plan options.
“A competitive private market can deliver more choice, higher quality and lower costs,” the group said. “We will work across the aisle — with every policymaker and the new administration — to find solutions that deliver affordable coverage and high-quality care for everyone.”
About 20 million Americans have gained insurance coverage since the law was passed in 2010 through its marketplace subsidies, Medicaid expansion and requirements that insurers cover children up to age 26.
Getting rid of those elements immediately, without helping people buy replacement plans, would deprive Americans of health insurance they have already purchased and planned to use during 2017. Healthcare experts note that could make immediately repealing the law politically difficult.
Congress may just vote symbolically to repeal the healthcare law and then take more time to figure out how they want to replace it, said Kaiser Family Foundation Vice President Larry Levitt.
Those ideas could come from a healthcare plan House Republicans unveiled over the summer, which would replace the marketplace subsidies with a refundable tax credit to buy coverage and gradually phase down extra funding for Medicaid expansion, among other provisions.
“I think outright repeal of the [Affordable Care Act] is far from a sure thing,” Levitt said. “No incoming administration can take on everything they’ve promised. They’ll have to set priorities.”
