In a vote of 244 to 185, the House of Representatives has repealed the Affordable Care Act — just days after the Supreme Court upheld its constitutionality.
This is the 31st attempt by Congressional Republicans to eliminate the measure. The GOP has spent an estimated “88 hours and 53 minutes” since January of 2011 trying to undo the reform, an analysis by Democratic Leader Nancy Pelosi’s (D-CA) office finds, though this latest bill is expected to die in the Democratic-controlled Senate.
Prior to Wednesday’s repeal vote, Democrats introduced an amendment that would have forced members of Congress to forego the same protections that Republicans are seeking to eliminate for their constituents, including gender-based premium rating, prohibiting insurers from discriminating against people with pre-existing conditions, and allowing young people to remain on their parents’ health plans until age 26. The amendment failed along party lines, as the GOP prevailed, ignoring the consequences of repeal:
5 Democrats supported the GOP effort. They are: Reps. Boren (OK), Kissell (NC), Matheson (UT), McIntyre (NC), and Ross (AR)
On Monday evening, Rep. David Dreier (R-CA) said that insurance companies should be allowed to discriminate against people with brain tumors during a House Rules Committee debate of the GOP’s bill repealing the Affordable Care Act. The law, which Republicans will vote to eliminate on Wednesday, includes a provision prohibiting insurance companies from turning away sick people.
But Dreier suggested that these individuals would be better off enrolling in state-based “high-risk insurance pools,” that could offer coverage to the individuals who are turned away from the individual health care market because they are too costly to cover:
DREIER: And I believe my state of California has a structure in place to deal with pre-existing conditions. It’s a pooling process, which I think is one worthy of consideration, because while I don’t that think someone who is diagnosed with a massive tumor should the next day be able to have millions and millions and millions of dollars in health care provided, I do believe that there can be a structure to deal with the issue of pre-existing conditions.
The Affordable Care Act already includes a high-risk pool program that acts as a bridge to 2014, when the new regulations prohibiting discrimination go into effect. 67,482 individuals have already benefited from the program, although the high cost of insuring sick people means that it is not sustainable over the long-run.
The economy may be struggling to create enough jobs to keep up with population growth, but Republicans are busy drafting legislation to repeal the Affordable Care Act — a law which the Supreme Court upheld last week and has already extended coverage for thousands of uninsured Americans.
On Monday, the GOP will convene an “emergency” meeting in the Rules Committee so they could hold a vote on The “Repeal of Obamacare Act” as early as Wednesday July, 11. The seven page messaging bill compiles the best Republican talking points against the law since it passed in 2010, but offers only the smallest hint of how the party plans to extend coverage to the millions who would lose it. “The path to patient-centered care and lower costs for all Americans must begin with a full repeal of the law,” the bill says on page six.
This free market mantra may resonate with the GOP base, but it does nothing to improve the economy or solve the health care crisis. Below are 5 consequences of the GOP’s repeal legislation:
1) Millions without coverage. A Congressional Budget Office analysis of the GOP’s repeal measure from 2011 found that “32 million fewer nonelderly people would have health insurance in 2019, leaving a total of about 54 million nonelderly people uninsured. The share of legal nonelderly residents with insurance coverage in 2019 would be about 83 percent, compared with a projected share of 94 percent under current law (and 83 percent currently).”
2) Health insurance costs increase. The same analysis concluded that “many people would end up paying more for health insurance— because under current law, the majority of enrollees purchasing coverage in that market would receive subsidies via the insurance exchanges, and [repeal] would eliminate those subsidies.” What’s more, “Premiums for employment-based coverage obtained through large employers would be slightly higher.”
3) Americans with pre-existing conditions will lose access to coverage. Republicans have said that they would not replace the Affordable Care Act’s federal rules prohibiting insurers from discriminating against people with pre-existing conditions. Instead, they would encourage states to form expensive high-risk pools to cover the sick or, alternatively, leave them to find their own coverage in the individual market — where many will likely go uninsured.
4) Medicare in disarray. Approximately 100 million Medicare claims are processed each month using a formula that was altered by the Affordable Care Act. Should the law be repealed, new rates could not be calculated under the old, pre-ACA formula until after a rulemaking process that can take months before is completed. The result would be that Medicare would not be able to pay doctors for what could be many months.
5) Deficits increase by billions. The CBO predicts that “as a result of changes in direct spending and revenues is likely to be an increase in the vicinity of $230 billion.” Repeal would also “increase federal deficits in the decade after 2019 by an amount that is in a broad range around one-half percent of GDP.”
During an appearance on Hugh Hewitt’s radio show on Tuesday, Sen. John Thune (R-SD) pledged that Republicans would kickstart the process of repealing the Affordable Care Act shortly after the November elections and predicted that the party would be able to undo the law through the budget process “by sometime in the spring.”
Unimpressed by the timeline, Hewitt pressed Republicans to move faster. He compared the urgency of repeal to Congressional action in the aftermath of the 9/11 attacks and argued that people are already “dying” from the law. Thune seemed to agree with the sentiment:
HEWITT: Yeah, the reason I balk a little bit is only because I know people are out there dying under the burdens of this thing.
HEWITT: And they expect, you know, the light speed for Congress is like molasses for the rest of the real world.
HEWITT: And so it just seems to me that after 9/11, you guys moved fast, and I would hope it would happen again.
The Congressional Budget Office estimates that if Republicans eliminated Obamacare in its entirety, more than 30 million Americans would go without coverage, “people would end up paying more for health insurance,” “the average insurance policy in this market would cover a smaller share of enrollees’ costs,” “premiums for employment-based coverage obtained through large employers would be slightly higher,” and the deficit would grow by $230 billion.
Senate Minority Leader Mitch McConnell (R-KY) reiterated the GOP’s commitment to taking away health care insurance from millions of Americans who are expected to receive coverage as part of the Affordable Care Act, if Republicans win Congressional majorities in November.
The senior senator from Kentucky, who himself enjoyes government-subsidized insurance as a federal employee, told the National Review on Tuesday that the party would do little to help the 129 million people who could be denied insurance because they suffer from a pre-existing condition should the law be repealed. “I’m not convinced that issue needs to be addressed at the federal level,” he said, before praising Republican governors for refusing to implement a provision of the law that expands health coverage to lower-income residents through the Medicaid program.
During the interview, McConnell also confirmed that he planned to repeal Obamacare’s main provisions — like the individual mandate — through reconciliation, a process that allows the Senate can pass budget-related bills with a majority vote:
MCCONNELL: Repeal of Obamacare will be the first item up in the Senate if I am majority leader. If we have a president who will sign the bill, we will do everything we can to get it off the books, and we’ll be looking for every angle that could be pursued. There has been a lot of talk about reconciliation. The Chief Justice said this is a tax, and we take him at his word, so that certainly makes this eligible for reconciliation. But that may not be the only avenue that we pursue.
But Republicans had lambasted Democrats for using the reconciliation process to pass the law in 2010, arguing that it would be “ripping a piece of the fabric of America off.”
McConnell himself bemoaned the practice. “Reconciliation has never been used to do anything as massive as restructuring 1/6 of our economy,” he said. For Democrats “to step in and use this little-used parliamentary device never intended to do something of this magnitude.” Now, his party is prepared to “undo” the measure and revert “1/6 of our economy” back to that status quo of unsustainable health care costs and limited access.
By Amanda Peterson Beadle on May 17, 2012 at 5:56 pm
Congressional Republicans have promised to “repeal and replace” President Obama’s health care reform law, but they still have not agreed on what that should look like. Today, Speaker John Boehner said every part of Obamacare needs to be removed:
“We voted to fully repeal the president’s healthcare law as one of our first acts as a new House majority, and our plan remains to repeal the law in its entirety,” Boehner said to reporters. “Anything short of that is unacceptable.”
But Republicans have yet to offer a viable alternative that would that would fill the void left by the law and provide coverage to the 30 million Americans who would lose insurance without Obamacare. Politico reported this morning that GOP leaders have quietly begun to float a piecemeal plan that may provide limited insurance coverage to a small portion of the uninsured. Republicans have said they would preserve the most popular provisions, like allowing young adults to stay on their parents’ health insurance until age 26, without the individual mandate that helps pay for the regulations.
But the GOP’s internal disagreement and unwillingness to offer a unified comprehensive plan suggests that they consider health care a low legislative priority. For instance, Rep. Paul Ryan (R-WI) — the GOP’s spokesman on economic issues — told the Washington Examiner on Thursday that the party will “articulate our vision” to replace the law, but wouldn’t necessarily offer a legislative solution.
This approach contrasts sharply from Republican’s pledge to “replace” reform as soon as it became law in 2010. Boehner promised in 2010 to “replace it with common-sense reforms,” and Ryan said in a 2011 speech that Republicans can’t stop at simply repealing the law and “have a responsibility to fix the broken network of government policies that have made such a mess of health care.”
But now that their strategy looks like nothing more than tossing out a law that helps expand access to health insurance while controlling costs, Republicans are telling the uninsured and those worried about rising health care costs that they are not concerned about fixing their problems.
MAP: Women Would Pay Higher Premiums Than Men If SCOTUS Strikes Down ACA |
The Affordable Care Act includes a provision that prohibits health insurance companies from charging women higher premiums than men. Should the Supreme Cout overturn the law, however, women who purchase health care in the individual market could pay up to 100 percent more for their health care coverage in some parts of the country:
Republicans are absolutely gleeful about the possibility that the Supreme Court may strike down the Affordable Care Act, despite the fact that doing so would increase premiums, cause millions to lose health insurance, and ultimately raise health care spending.
Now, several health experts are warning of another unintended consequence: Medicare might not be able to function properly, potentially putting patient care and payments to doctors at risk. As some experts told NPR, the program could be thrown into complete chaos:
“The Affordable Care Act has become part and parcel of the Medicare system, encouraging providers to deliver better, more integrated, better coordinated care, at lower cost,” says Judy Feder, a public policy professor at Georgetown University and former Clinton administration health official. “To all of a sudden eliminate that would be highly disruptive.”
Sara Rosenbaum, a professor of health law and policy at George Washington University, puts it a bit more bluntly: “We could find ourselves at kind of a grand stopping point for the entire health care system.”
And it’s not just Democrats warning of potential problems. Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush, says she doesn’t think it’s likely that the court will strike down the entire health law. But if it does, she says, “it seems like it takes everything with it, including those aspects that are only very peripherally related to the expansion of coverage.”
As Rosenbaum noted, if the law is ruled unconstitutional, “Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly, closing the doughnut hole might not happen. We don’t know.”
This uncertainty is already spilling over into the market: the ratings service Moody’s reported earlier this month that for-profit hospitals could be hit particularly hard if the law is overturned. As the report said, “Uninsured patients enter the health care system through the emergency room and often wind up admitted and accumulating bills they don’t have the means to pay. The continued rise in uncompensated care costs would limit operators’ revenue growth and profit margins and constrain cash flow.”
Health Care Industry Full Steam Ahead In Implementing Reform |
The changes unleashed by health care reform may survive regardless of the Supreme Court’s ruling on the constitutionality of the Affordable Care Act, health care executives predict. Just like states — some of which have taken big steps to implement the measure — a growing number of industry officials say the law has “unleashed momentum for changes in the market and provided benefits” that they want to keep. “The Affordable Care Act has many component parts, and it’s likely that even if the court rules that sections of the law are unconstitutional, other sections of the law will remain in effect or be reinstated through other congressional action,” said Grand View Hospital CEO Stuart H. Fine, reflecting the growing consensus that hospitals and the health insurance industry see the ACA as the law of the land and are moving quickly to implement many of its changes.
WASHINGTON, DC — Though one of the key successes — and most popular aspects — of the Affordable Care Act is the provision banning insurance companies from denying coverage to people with pre-existing conditions, Sen. Jim DeMint (R-SC) thinks they were better off before the law passed.
ThinkProgress spoke with DeMint outside a tea party rally nearby where the Supreme Court heard oral arguments on the constitutionality of the individual mandate. The second-term South Carolina senator called the pre-existing condition clause simply an “excuse for government to run health care.” We asked whether people with such conditions would get less health care under Obamacare than they did prior to its enactment. “They probably will,” declared DeMint.
DEMINT: I can guarantee you people with pre-existing conditions are going to get less health care—lower quality health care—under Obamacare than they would under a state-run plan.
KEYES: Do you think they get less health care under Obamacare than they did before Obamacare was enacted?
DEMINT: They probably will. It will definitely cost more for everyone and it will be inefficient and it won’t be as patient-focused. And so we need to make sure that we do the thing the right way and there are ways that everyone can have insurance, and that’s our goal.
While DeMint may think care will be worse for those with pre-existing conditions, this is simply not true. Nearly 50,000 people previously turned down because of a pre-existing condition have already been able to receive health care because of the ACA and the new Pre-Existing Condition Insurance Plan that the law created. Already, health care reform has stopped discrimination against children with pre-existing conditions. By 2014, that same law will apply to all adults, ensuring that everyone with an existing medical problem is able to get the care they need.
Republicans are currently pushing for the repeal of the ACA as the Supreme Court hears a case on the constitutionality of the individual mandate section of the law. If the mandate were to be repealed, health insurers would likely have to once again deny coverage to those with pre-existing conditions, because it would be unsustainable to have an insurance pool made up of only “high risk” people.
Yet for DeMint, that world where insurance companies could deny health insurance to people with pre-existing conditions is not only preferable, but somehow better for such people. If Republicans get their wish, DeMint’s vision may soon be realized at the expense of health care for millions of Americans with existing medical problems.