Thursday, December 22, 2016

Hmmmm...Team Trump queasy about ACA insta-repeal?

I credit nothing said by Team Trump...but this does not sound like ACA repeal:
“The enrollment numbers announced today show just how important health care coverage is to millions of Americans,” said Phillip J. Blando, a spokesman for the Trump transition team. “The Trump administration will work closely with Congress, governors, patients, doctors and other stakeholders to fix the Affordable Care Act’s well-documented flaws and provide consumers with stable and predictable health plan choices.”
Most political writers seem to take it as a foregone conclusion that Republicans in Congress will execute on their announced "repeal-and-delay" strategy -- using reconciliation to instantly repeal the taxes that fund ACA benefits, while maintaining the marketplace with its tax credits, and possibly the Medicaid expansion, for two or more years. The theory is that Republicans could then pull Senate Democrats into supporting a "replace" bill to be enacted as the ACA benefits phase out.  (Never mind that Republicans have not been able to coalesce on a replace bill for six-plus years.)

While a budget reconciliation bill requires just 51 votes for passage, several Republican senators have expressed reservations about passing a substantial repeal without a replacement.  They include Susan Collins, Lamar Alexander and Bill Cassidy, who suggested yesterday that at last some tax revenue should be left in place to provide funding for benefits in a replace bill.

Progressive groups are readying what should be a massive lobbying campaign to pressure Republican senators and congressional reps in states that have benefited strongly from the ACA, particularly in red and purple states that have enacted the ACA's Medicaid expansion. Many of those states have cut their uninsured rates by half, and -- perhaps more importantly for Republican lawmakers -- improved their hospitals' financial position by sharply reducing uncompensated care.

While the pressure from Republican leadership to get on the insta-repeal train is likely to be enormous -- recall that no Republican senators jumped ship to vote for ACA passage -- there is also the potential for ample counter-pressure from hospitals, insurers and the law's beneficiaries to hold back from collapsing the individual insurance market and gutting the revenues that would fund any Republican redesign.

Trump's nominee for HHS secretary, Tom Price, is a dead-end mortal enemy of the ACA and author of a radically inadequate replacement. Phillip Blando is...what? -- a pharma industry lobbyist (and former healthcare consultant) as far as I can tell. Most Trump transition pronouncements are worth no more than Trump's denials that he's a lifelong sexual predator.

Nonetheless...the hint here that the consequences of insta-repeal may be registering to some degree with Team Trump must count as good news of a sort.

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