Repealing and replacing the Affordable Care Act (ACA) was an oft-repeated promise on the campaign trail, invoked by the President as well as congressional Republicans. Even before the President’s inauguration, conversations had begun about a quick timeline to repeal and replace the ACA.
The expectation was that the Republican agenda, with healthcare at the top of the list, would be easily implemented in an environment where Republicans hold the White House and a majority of both houses of Congress. However, the reality of governing soon set in. After a series of false starts to bring the Freedom Caucus and more centrist members together, on May 4, 2017, the House passed H.R. 1628, the American Health Care Act (AHCA), to repeal and replace the ACA. CDA lobbied in support of the bill because it repealed the employer mandate and made other changes that reflect a free market approach to healthcare. The President hosted an event in the White House Rose Garden to celebrate its passage.
Senate passage proved more difficult. After multiple attempts to bring a Senate version of the bill to the floor throughout the late spring and early summer, just before the August recess the Senate finally brought the House bill to the floor for consideration and amendment. Several compromise amendments failed, as did a bill to repeal the ACA without a replacement. In a dramatic turn of events, three Republican Senators voted in opposition to the “skinny repeal” bill intended to be a vehicle for a compromise with the House, essentially ending congressional consideration of a large-scale reform effort for the time being. Majority Leader Mitch McConnell (R-KY) said, “It’s time to move on.”
The President had suggested that he may take administrative action that will hasten the unraveling of the ACA. Under the ACA, insurance companies have been paid subsidies through a cost-sharing reduction (CSR) program to shore up the exchanges. At this point it is unclear whether the President will continue to authorize the payment of these subsidies, but some centrist Republicans have indicated they will introduce legislation to shore up the exchanges and stabilize the market. H.R. 1, the Tax Cuts and Jobs Act, which was signed into law in late 2017, repealed the individual mandate. It seems likely that the disruption in the marketplace, uncertainty for insurers and upheaval for participants in the exchanges will require some legislative activity around healthcare in the coming months.
CDA will continue to stay engaged in the debate on healthcare and will advocate for policies beneficial to the convenience distribution industry, such as repeal of the employer mandate.