Congress is poised to repeal the Affordable Care Act. What might replace it?
THE last time President Barack Obama counted, congressional Republicans had tried to repeal parts of the Affordable Care Act (ACA), his health-care law, more than 60 times. Donald Trump’s election victory means their efforts will no longer be in vain. Yet despite Republicans’ confidence in Obamacare’s shortcomings, what exactly will happen to the law when Mr Trump takes office remains something of a mystery.
Because Republicans lack the 60 votes necessary to overcome a filibuster in the Senate, they will be unable to pass a comprehensive health-care bill without Democratic votes. Instead, they must rely on a process dubbed “budget reconciliation”, which allows a simple majority to pass tax-and-spending measures. Republicans used this process to send a law repealing parts of Obamacare to the president’s desk. Mr Obama vetoed it early this year. Next year, President Trump will probably sign it.
That will be the beginning, rather than the end, of the Republicans’ task. On its own, the reconciliation bill is best described as a wrecking effort. It would remove the subsidies currently available to poor buyers on the ACA’s insurance exchanges. It would nix the individual mandate, which fines Americans who can afford health insurance but go without it. Both moves would reduce the number of healthy people buying coverage. But a rule banning insurers from turning away those with pre-existing medical conditions would remain. As a result, premiums, already up by an average of 22% this year, would rise further, deterring yet more healthy customers. The “death spiral” that some say already afflicts the exchanges would thus accelerate.