Vice President Mike Pence is yet again the “tie-breaker” in Senate deliberations. Pence’s vote on February 7, 2017 enabled Betsy deVos to become confirmed as Education Secretary, and today—on July 25, 2017—his vote enabled Senate Majority Leader Mitch McConnell (Republican) to force debate on the Republicans’ health-damaging bill to repeal the Affordable Care Act (ACA). Two female Republican senators voted against the bill, as well as all 44 Democrats.
First Target of “Skinny” Repeal Plan
According to a New York Times article on July 25, 2017, more likelihood exists that—rather than attempt to repeal the entire ACA right now—McConnell will target aspects of the ACA for a repeal vote. This is because of the expected failure of a Senate attempt to repeal the entire ACA without a realistic replacement; no replacement plan was agreeable to both Republican moderates and conservatives. One primary target is anticipated to be the “individual mandate” (requiring all Americans to have health insurance coverage) that is central to the ACA.
As highly complex law, the ACA includes numerous provisions aimed at regulating the insurance industry. These provisions were included in order to prevent insurers from pulling out of the ACA‘s federally-subsidized marketplace and/or raising premiums to an unaffordable level for the majority of the population. One essential ACA provision required both healthy and sick individuals to purchase insurance, so that enrollment would not be skewed toward sick individuals with high utilization. Typically called the “individual mandate”, this provision was considered crucial to acquiring insurer “buy-in” in tandem with reigning in insurance costs.
Eliminating the “individual mandate” is popular with Republicans (and especially with Trump supporters) because they consider it to represent government interference in the private sector. However, the overturning of the “individual mandate” will enable healthy individuals to forego insurance. In turn, this is anxiety-provoking to the insurance industry that depends upon healthy individuals to offset their costs.
Without enough healthy enrollees, the insurance companies believe that they run a high risk of financial ruin. For this reason, insurers are likely to increase their departure from the individual marketplace or raise premiums as a bulwark against the anticipated revenue loss.
Trump Administration Goal of ACA Failure
Trump and congressional Republicans want the ACA to fail due to their resistance to government involvement in the healthcare system, as well as their contempt for former President Obama. They may cause abject misery to much of the nation’s population in an effort to achieve a legislative victory. (The CBO report predicted passage of the Republican ACA-replacement bill would cause a loss of insurance for 22 million Americans within 10 years.) In their endeavor to defeat a health plan supported by Democrats, they are willing to ignore the impact of their political decisions on human beings’ lives. We’ll probably know if these self-serving and short-sighted Republican senators have succeeded in undermining our healthcare system in the near future.
Second Target of “Skinny” Repeal Plan
Another repeal target according to the previously-noted New York Times report is likely to be the ACA subsidies to insurance companies for participating in the individual marketplace. Eliminating the subsidies will assuredly cause increased insurance company anxiety, prompting them to pull out of the federally-subsidized marketplace and/or foster the raising of insurance premiums and deductibles. Trump and the Republican Congress will have then achieved their goal of showing that the ACA is failing; however, they will actually have caused its failure.
Third Target of “Skinny” Repeal Plan
The tax on businesses included as a provision of the ACA is yet another of the chief targets. Its purpose was to generate federal revenues to subsidize the purchase of private insurance through the government-facilitated marketplace, in the form of tax credits for persons with incomes below 400 percent of the Federal Poverty Level (FPL) and subsidies for persons with incomes below 200 percent of the FPL.
Prior to enactment of the ACA, a large proportion of the population could not obtain either health insurance or medical care. It should not be a Trump Administration or Republican goal to turn the clock back to a pre-ACA healthcare delivery system.
Trump's Healthcare System Reform Plans 