ACA Repeal Back on Table

September 20, 2017

Republican lawmakers, along with President Donald Trump are throwing their support behind a last-ditch effort to repeal the Affordable Care Act (ACA), rather than make targeted fixes to the law. While the bipartisan talks between Senate HELP Committee Chair Lamar Alexander (R-Tenn.) and Ranking Member Sen. Patty Murray (D-Wash.) had been gaining traction, many Republicans raised concerns about the approach, which would provide money to shore up ACA while offering few concessions to conservatives.

Anger over opting to make fixes to ACA in-lieu of “repeal-and-replace” has grown among the Republican base, spurred by President Trump’s criticism of Congressional Republicans’ failure to repeal the law earlier in the year. That growing frustration led to Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) to craft their version of repeal-and-replace legislation which is now the focal point of ongoing discussions.

House Speaker Paul Ryan (R-Wisc.) told Republicans that the Senate’s bipartisan fix, which provided funding for ACA’s cost-sharing subsidies, was a “red line” for the House. The White House also told Republican leaders that providing ACA subsidies without repeal would not work.

Trump, Ryan and Senate Majority Leader Mitch McConnell (R-Ky.) have thrown their support behind the Senate’s last hope for repeal, the Cassidy-Graham proposal which would: turn federal health care programs into state block grants; repeal ACA’s coverage mandates; wind down the law’s Medicaid expansion; and cap Medicaid spending for the first time since the entitlement program’s inception.

Lawmakers only have until Sept. 30 to pass a repeal bill with a simple majority under the rules of budget reconciliation. Democrats have requested a CBO score for the bill, though that’s not likely to be completed for weeks.

A bipartisan group of 10 governors, including Ohio Gov. John Kasich (R), Colorado Gov. John Hickenlooper (D), Alaska Gov. Bill Walker (I) and Nevada Gov. Brian Sandoval (R), asked Senate leaders to not take up the Graham-Cassidy repeal legislation. The governors, in a letter, instead urged the Senate to focus on bipartisan health care legislation, and touted the legislation from Sens. Alexander and Murray as a path forward. “Only open, bipartisan approaches can achieve true, lasting reforms,” the governors wrote.

NSBA has, for many years, worked to ensure small-business priorities are well represented in Congress and has offered its own platforms for reform, citing that any reform process must be bipartisan, seek stakeholder input and be transparent.

Under the ACA, according to NSBA survey data, 69 percent of small firms experienced premium increases exceeding 20 percent. The lynchpins to successful health care reform are: affordability, universal access, individual responsibility, proper market-based incentives, improved quality and eliminating wasteful care.  NSBA is also calling on lawmakers to take a serious look at the drivers of health care costs: rewarding procedures instead of outcomes; hidden pricing structures; electronic records that fail to properly transport and communicate for the patient; and rampant defensive medicine.

NSBA recently weighed-in with Senate Finance Committee Chair Orrin Hatch in a letter that outlines specific fixes necessary to the ACA. Please click here to read the full letter.