The Uncharted, Choppy Waters of Obamacare Repeal

Repealing Obamacare sounded so easy, but replacing the health insurance measure has proven more complicated and politically challenging and may wind up morphing into a repair job on the health care plan that some hate and others have vowed to fight to protect. Photo Credit: Brennan Linsley/AP

Repealing Obamacare sounded so easy, but replacing the health insurance measure has proven more complicated and politically challenging and may wind up morphing into a repair job on the health care plan that some hate and others have vowed to fight to protect.

Photo Credit: Brennan Linsley/AP

Repeal of Obamacare has slipped from a task on Day One in the White House for President Trump to a repair job that may stretch into 2018. As Trump and congressional Republicans have disconcertingly discovered, replacing Obamacare may be more popular than repealing it. 

Over the weekend, Trump signaled the timetable for repealing and replacing Obamacare has slipped and is likely to morph into something closer to an extensive repair job on the highly politicized national health insurance program, which includes an individual health insurance market and expanded Medicaid coverage.

The lengthier timeline isn’t all that surprising. Since Republicans took up the chant to repeal Obamacare six years ago, they have been hard pressed to reach consensus on an alternative strategy, not to mention an actual replacement plan. Town hall meetings for congressmen have turned into angry forums about what will replace Obamacare if it is repealed. Some congressmen have canceled town halls as a result.

It is unclear whose playbook Republicans will follow. The move to repeal Obamacare and come up with a replacement later apparently has been stripped from the playbook. Trump, in his first press conference after his inauguration, predicted Obamacare would be repealed and replaced more or less simultaneously soon after Tom Price was confirmed as his secretary of Health and Human Services. Price has yet to be confirmed by the Senate and Trump told Bill O’Reilly in a Super Bowl halftime interview that repeal-and-replace may not happen until next year.

Congressional Republican leaders have signaled action is possible as soon as this spring, even though a firm set of actions hasn’t been publicly presented. Oregon Congressman Greg Walden told constituents in Southern Oregon any replacement plan would retain the ban on denying health insurance coverage to people based on pre-existing conditions. As chair of the House Energy and Commerce Committee, Walden will play a leading role in shaping an Obamacare replacement. The major stumbling block for moving ahead, Walden acknowledges, is finding a way to pay for the Obamacare provisions that will be retained.

There are a lot of interrelated parts in Obamacare that complicate coming up with a replacement, let alone a replacement that is less costly and ensures the same level and quality of care. Congressional politics play a role, too. Republicans can use the budget reconciliation process to lop off financial aspects of Obamacare, but not to enact replacement features. The replacement ultimately will need 60 votes to pass in the Senate, where Democrats have promised to fight anything that eviscerates Obamacare in the name of replacing it.

This is where the idea of repairing Obamacare comes in. Two GOP senators have already introduced a bill that would let individual states the option of preserving Obamacare as an alternative to whatever Congress settles on as a replacement health insurance mechanism. Called the Patient Freedom Act of 2017, the measure, according to its principal sponsor, Senator Bill Cassidy, R-LA, would eliminate the individual and employer health insurance mandate, but leave the consumer protection provisions of Obamacare in place.

Cassidy’s bill would allow states such as Oregon to retain Obamacare individual health insurance exchanges and expanded Medicaid coverage, but federal support would be trimmed by 5 percent. That cut would be in addition to the phased-down subsidy to states that was part of the Obamacare legislation and goes into effect this budget biennium.

A related health care action by Trump also has taken a U-Turn. During his campaign, Trump said he would push pharmaceutical companies to drop prices on prescription drugs and after his election promised strong action, such as negotiating drug prices for Medicare and Medicaid. However, after meeting with drug industry officials and lobbyists, Trump suddenly changed course and expressed sympathy for the pharmaceutical industry, which says the uncertainty of clinical trials and the short time frames when drugs can be patented are the real drivers behind prices.

Many states, including Oregon, are trying to address the cost of drugs, which is a significant factor in rising health insurance premiums.