The repeal and replacement of the Affordable Care Act (ACA) is one Trumps biggest agenda items for his first term. As recently as February 16, 2017, House Speaker Paul Ryan stated, “It has become increasingly clear that this law is collapsing,” and that, “It will keep getting worse unless we act.” In his statement, Ryan speaks to the ever-increasing insurance premiums that the American people are forced to pay, while their co-pays have gone up and their access to quality physicians has gone down.
Currently, House Republicans are working towards a replacement plan that they believe will be lower costs and increase access for most Americans. As of now, there is a substantial difference of opinion regarding healthcare reform between Republicans and Democrats. Many Democrats support a single-payer system which would effectively eliminate the insurance companies and give the government complete control over your health care decisions. Democrats claim that this single payer system would work “just like the VA” and provide the same level of quality care to all Americans that we provide our veterans. First, our VA is not the model you want this country to emulate. In the past years it has been proven that incompetence at the VA has led to the deaths of many of our nations most decorated veterans. Sadly, the issues with VA have been around for many years. When my dad was doing his residency in the early 80s as an internal medicine physician, one of his rotations was at the VA in Birmingham. On one occasion while he was working there he heard an alarm go off which meant that a patient was going into cardiac arrest and if he didn’t resuscitate this patient quickly they would die. The normal practice is that when someone is going into cardiac arrest the nurse will go to the room with the doctor to help them revive the patient. However, when this cardiac arrest code went off my dad had to run through the halls and try to find this patient who was in imminent danger of dying and finally he went to the nurses station and asked “what room is this patient in” and the nurse pointed to the room with a chicken wing in her hand and my dad was thankfully able to revive the patient. Obviously he was very angry and confronted the nurse and said why didn’t you assist me in reviving this patient and she said that “she was on her break and hadn’t finished eating her dinner”. Well my dad justifiably let her know his thoughts on the matter and the next day the person who got in trouble was not the nurse who was more than happy letting a veteran die rather than take two minutes away from her dinner, it was my dad who apparently wasn’t sensitive enough to this “so-called”nurse. The problem with giving the government control of our healthcare is that it is almost impossible to fire someone and unlike the private marketplace where you can promote people based on merit, the way you advance in the government system is much different. So if any politician ever says they want to make healthcare run like the VA you need to do everything in your power to make sure that person never wins an election or you may be the person who goes into cardiac arrest during a dinner break and good luck suing the government for negligence because your chances of recovering damages on this when it is in the hands of the government will be slim to none.
That being said the Republicans prefer a replacement plan with health savings accounts, tax credits to help pay for insurance, and high-risk pools for the chronically sick. The Republicans aim to create a more patient-centered system, allowing for greater choice among insurance companies and healthcare providers. The House Republicans’ blueprint also includes a change in Medicaid payments. Under the ACA, the federal government covers the majority of insurance costs for the Medicaid population. Under the Republican’s proposed plan, states would be reimbursed with block grants. Block grants would limit Medicaid spending, which is currently reimbursed as a percentage of whatever each state spends. Although the House leaders have laid out this general repeal-and-replace plan, a definitive plan has yet to be formulated. As of now there is just speculation as to what the final product will be and if states will end up losing federal funds.
Considering the general formatting of plans to repeal-and-replace the ACA, it is important to follow two individuals throughout the next few months. First, we should follow statements made by Representative Kevin Brady, chairman of the Ways and Means Committee, as tax credits are a large portion of Republicans’ repeal-and-replace plans. Representative Brady has discussed tax credit options with a number of congressmen, as well as a potential widening of health savings accounts. At this point, Representative Brady’s opinions are rather broad. Brady stated, “We’re really looking at a whole range of options.” Although this statement is extremely general, it is important to continue following Representative Brady’s statements and opinions, as his committee will be incredibly influential in the passage of a replacement bill.
The second person to follow is Tom Price, President Trump’s appointment for Secretary for the Department of Health and Human Services. Price is decidedly against abortion-providing organizations and strongly supports employers’ rights to delegate the level of reproductive healthcare employees receive. While a member of the House of Representatives, Price proposed his own vision for health care reform, The Empowering Patients First Act of 2015. This plan significantly mirrors the plan House Republicans are currently pushing, including giving tax credits to pay for insurance and creating health savings accounts. Considering Secretary Price’s history, it is likely he will gladly support and adopt most anything House Republicans pass in regards to healthcare reform.
With the repeal of the ACA, replacement is vital. Replacement is necessary, as a total repeal without a replacement would disrupt millions of Americans’ healthcare. Many fear, without a replacement, insurers selling individual health plans will exit the market because they will no longer be subsidized. Replacing the ACA would minimize the potential fallout.. Replacement is a complicated issue and undoubtedly much more is to come, but so far, House Republicans appear off to a good start.
Mr. Reid is general practice attorney in Birmingham Alabama. He has worked for Republican leadership in the United State House of Representatives in Washington, DC, and was a health policy advisor to the Governor of Alabama. You can contact him by email at [email protected] or by phone at 205-913-7406. A description of his practice areas is available at www.reidlawalabama.com.
