President Obama criticized Congressional Republicans’ plans to "repeal first and replace later," calling their intention to repeal the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) without first creating a replacement plan "irresponsible." In a New England Journal of Medicine perspective piece, Obama took pen to paper for the second time in six months to publicize the benefits of the ACA (see President Obama assesses ACA’s legacy,offers suggestions, July 13, 2016). He emphasized the careful planning that went into passing the bill—"more than a year of public debate"—and warned that, without a replacement plan, "the health care system will be standing on the edge of a cliff" as stakeholders potentially remain inactive while waiting for what comes next.
ACA Repeal. Republicans have made repeal of the ACA a top priority for the new Congress. As one of its first acts, the body released a budget containing reconciliation instructions affecting spending and revenue. Although the action is insufficient to repeal the entire ACA, it lays the groundwork for repealing tax credits, Medicaid expansion, and insurance mandates (see Senate races towards repeal through reconciliation process, January 4, 2017). Sen. Mike Enzi (R-Wyo), who introduced the bill calling for the repeal of "Obamacare," believes repeal will "improve the system so more people can get better health care, not just coverage." Speaker of the House Paul Ryan (R-Wis) accused Democratic opponents of scare tactics and promised, "we will have a suitable transition time period so that there is a better place for people to go, and we don’t pull the rug out from under anybody while this transition period occurs." Sen. Rand Paul (R-Ky), argued that the Congress should vote on repeal and replacement at the same time and claimed that President-elect Trump expressed support for his position in a recent phone call.
President’s argument. President Obama noted that while a majority of Americans receive health care coverage through non-ACA sources, such as employers or Medicare, many of them still benefit from ACA protections, including free preventive services. He admitted to flaws in the act often cited by opponents, including a lack of choice in health insurance markets and unaffordable premiums, but suggested that the ACA should be improved, rather than gutted. Regardless, he indicated that Republicans planning to repeal the Act must have a plan in place, or risk placing stakeholders in limbo, potentially causing insurance companies to pull out of the marketplace or increase prices, physicians to stop investing in innovative care coordination approaches, and hospitals to scale back services and jobs. He cautioned that, once the ACA is repealed, there is no guarantee that a vote to replace it will ever occur.
In urging lawmakers not to act hastily, he noted the delicate interplay between various provisions of the ACA. For example, he stated that President-elect Trump wishes to maintain protections for people with preexisting conditions. He argued, however, that this cannot be done without requiring individual responsibility penalties—what he called a "Republican idea" learned from Massachusetts. Failure to uphold the penalty provision would "cost millions of Americans their coverage and cause dramatic premium increases for millions more."
Companies: New England Journal of Medicine
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