Tuesday, November 15, 2016

Trump and GOP sending mixed signals on ACA

Nov 15, 2016 | By Jack Craver

Days after completing a successful 16-month campaign during which he repeatedly vowed to rip up the Affordable Care Act, President-elect Donald Trump suggested he wanted to maintain at least two popular provisions of the ACA and even left the door open to not repealing the health law, but simply making changes to it.

“Either Obamacare will be amended, or repealed and replaced,” he said shortly after his election.

The team of experts Trump has assembled to consult with on health care are not big ACA fans, but nor are they radicals.

“(Trump) is choosing people that aren't crazy, just conservative in their thinking,” Steven Eastaugh, one of the architects of the ACA and a former Obama adviser, tells Modern Healthcare. “If there is going to be a retrenchment of the ACA, there would hopefully be minimal losses to access to care.”

I’ve spent 7 years trying to understand the health reform law, and while I guessed wrong on Trump, I do...

Trump’s ambivalence about gutting a law that has dropped the uninsured rate to historic lows was foreshadowed during his campaign, when he repeatedly promised to put in place a replacement plan that he said would result in universal coverage. He dismissed criticisms from fellow Republican primary opponents, such as Ted Cruz, who tried to brand him as a big-government liberal, saying that he was not going to allow people to “die in the streets.”

As Trump sends mixed signals about what he wants to do with Obamacare, Congressional Republicans have already begun to bicker about how to fulfill their six-year promise to repeal the law without eliminating coverage that millions of Americans depend on.

Cruz and others are pushing to scrap the ACA entirely. At least one GOP source tells The Hill the repeal legislation Congress approved (and Obama vetoed) last year should be the “baseline.”

Some Republicans, however, are voicing caution now that they have the ability to unleash the consequences of completely scrapping a bill that is credited with providing coverage for more than 20 million.

In some cases, the division is not about ideology. Conservatives who represent poor states and districts that have seen particularly large increases in coverage as a result of the ACA are concerned about the effect a full repeal will have on their constituents, and the political price they might pay as a result.

“We’ll see if we can reach some sort of consensus with our Democrat friends on how to make this repeal and replace. Clearly we don’t want to do any harm to people who are in the system now. We want to be mindful of that,” says Sen. Roger Wicker, R-Miss., according to The Hill.

Sen. Shelly Moore Capito, R-W. Va., has also voiced concerns about rolling back the Medicaid expansion that led to many in her state — one of the poorest in the nation — getting near-free health care coverage.

There are other areas of health policy that will likely divide the GOP. While the party was united in its opposition to the Cadillac Tax when its Congressional members voted to suspend the tax on expensive health plans last year, some of its leaders, notably Paul Ryan, have signaled that they would like to put in place something similar.

Ryan has previously written that excluding health benefits from taxation causes employers to push compensation towards benefits, resulting in lower wages for workers. But pushing for any type of new tax on benefits is going to be a tough pill to swallow for many Republicans, and likely for Trump.

“I would be dumbfounded if the entire exclusion were lifted,” says Joel Wood, senior vice president of government affairs for the Council of Insurance Agents & Brokers, in an interview with Modern Healthcare

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