Since the advent of the ACA, Republicans in Congress have at every opportunity tried to derail or repeal the Obama Administration’s Affordable Care Act. The mantra since 2017 has been “Repeal and Replace”. It may seem, once and for all, that repeal and replace is over.
Mid-term elections are a fraught prospect for all incumbent presidents. Every president since 1970 has seen a average congressional loss of 22 members. Today’s current congressional makeup is 225 Democrats and 211 Republicans in the House of Representatives and 50 Republicans, 48 Democrats, and 2 Independents that caucus with the Democrats. Any Democratic loss of Senate seats and more than 14 losses in the House will represent a full Republican sweep of both legislative chambers in Congress. The likelihood of this happening is high and so it is telling to hear, or more importantly understand what we are NOT hearing around “Repeal and Replace”. The only visible attempt at a broad agenda for congressional candidates is Sen. Rick Scott’s (R. – FL) 11 point Rescue America plan.
So, if a Republican controlled congress is not focused on repealing the ACA, what are they focused on? At present, it seems that conservatives are focused on changing certain provisions of the ACA and other federal laws to permit more consumer choices to purchase lower cost (and possibly lower value) insurance plans with fewer guaranteed benefit coverage protections. Some of the “new” policy proposals may look familiar:
- Association health plans
- Short-term insurance plans that allow for the sale of individual policies that leave out guaranteed ACA benefits and protections around preexisting condition exclusions
- Individual Contribution HRA’s (ICHRAs)
It should also be noted that two conservative healthcare policy think-tanks (the Foundation for Research on Equal Opportunity and the Goodman Institute) also include policy proposals that offer startup companies the monetary value of their employer insurance (including the federal tax deduction to let them choose their own plan) and a broader alternative coined “Medicare Advantage for All” which would use Medicare’s private health insurance option (known as Part C) as a national reform model.
Conservative politicians and health policy voices seem ready to confront any and all threats to the growing hegemony of Medicare Advantage and to find new opportunities to expand it.