The season finale of Repeal and Replace: Obamacare

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Laura Caccioppoli
July 25, 2017

The season finale of Repeal and Replace: Obamacare was certainly filled with drama and ended with a Shonda Rhimes level of “to be continued…” But do not fret, there will definitely be another season. Before we go into why there will be another season or what the plot may look like, let us do a quick recap of the season finale.

The episode started with Majority Leader, Mitch McConnell, being handed the American Health Care Act (AHCA) from his colleague, Speaker Paul Ryan. The AHCA was also reviewed by the Congressional Budget Office (CBO), and given less than stellar marks. In fact, the CBO projected 23 million more individuals would be uninsured, but the deficit would be reduced by $119 billion over 10 years. The AHCA would also allow states to waive essential health benefits, and even allow states to waive requirements preventing insurers from charging those with pre-existing conditions more for insurance. To get that $119 billion deficit reduction, drastic cuts in Medicaid were required.  The bill was an absolute disaster and the American people were not pleased — like when your bill is being called “the most unpopular piece of legislation Congress has considered in decades” you know it’s bad.

Fearless Majority Leader Mitch McConnell would bring together an elite group of Senators ready to face the challenge. The foreshadowing began when he invited another 12, for a total number of 13 Senators to work on the bill, 13. Unlucky, indeed! These senators alongside McConnell, worked tirelessly to create a piece of legislation capable of passing the Senate — the Better Care and Reconciliation Act (BCRA).

The bar was low. Since the GOP healthcare bill was technically a reconciliation bill, there could be no filibuster and only a simple majority was needed. Easy, given the Senate has 52 Republicans. Wrong! Republicans were forced to wait until after the July 4 recess before attempting to bring the BRCA to the floor. With the CBO projecting 22 million more uninsured Americans and cuts to Medicaid totaling $772 billion, but a $541 billion tax break for the richest Americans — It was no surprise  the Senate could not get any traction. And on July 18, the weight of the BCRA collapsed in on itself and imploded in a fantastical way — the Shonda Rhimes equivalent of a plane crash.

Sen. McConnell attempted a Hail Mary by pushing the BCRA to the side and attempting to repeal the Affordable Care Act without any replacement.  This too failed, as moderate Republicans realized that repealing without a replacement could end up far worse politically, and for real Americans, than leaving Obamacare in place.

Like most bad television, Repeal and Replace: Obamacare has been running for too long—seven years in fact; but that does not mean we cannot count on an eighth season. Here’s why:

While the number of Americans who proclaim to like Obamacare has been increasing over time, there are still problems. First, premiums are still rising, albeit, slower than they would have been without Obamacare.

Next, there are still many Americans who remain uninsured. Either they were unaware of financial subsidies, or were confused by eligibility rules for Medicaid. Perhaps, they had incomes that were too high to qualify for subsidies, or perhaps their employer offers health insurance, but at a cost that was not affordable. Whatever the reason is, many Americans are still without health insurance.

With national health expenditures somewhere in the three trillion-dollar mark, there is no doubt lawmakers will need to revisit this issue again soon. And, depending on how some members of the Republican Party are feeling, they have some options—dangerous options—to help advance their cause.

What might season eighths plot look like? Well, given that the House passed the AHCA by the tiniest of margins, and the Senate was unable to bring their version of the healthcare bill to debate—even though they only needed a simple majority—we know neither will have large roles next season. In fact, with the 2018 midterm elections around the corner, we might expect them to switch gears and focus on something — anything else, to show their constituents they in fact, did something in the past two years, which was worthy of reelection.

That said, the President can take action without Congress. He can weaken the enforcement of the individual mandate, he can make the tax credits for premiums less generous, he can eliminate subsidies for deductibles, and he can impose work requirements for Medicaid – all without Congress.

These actions would lead to a perfect storm. The individual mandates helps ensure that younger, healthier people enter the marketplace — offsetting the cost of older, sicker individuals and helps keep costs low(er). Subsidies and tax credits help make healthcare more affordable — allowing Americans to comply with the individual mandate. Lastly, Medicaid expansion helped those who cannot afford health coverage comply with the individual mandate. Without these mechanisms, the system would see rapid growth in cost of premiums and increased numbers of uninsured Americans. Ultimately, this would force Congress to make some sort of action.

So we end where we started off: to be continued…

Author: Laura Caccioppoli is a doctoral student in health policy at University of the Sciences. She has an MA in political science and a graduate certificate in nonprofit management from Villanova University. Laura serves on the board of The Consortium in Philadelphia and is Secretary of Americans for Democratic Action Southeastern Pennsylvania Chapter. Her research interests are in health and food policy, cultural competency and social justice. The views listed are her own, and do not represent the views of USciences, The Consortium, or Americans for Democratic Action.

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