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Can the Republican Party write another bill later to try to repeal the Affordable Care Act again? Or is it here to stay?

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    ...and if the subsidies stop being paid -- which doesn't require a legislative change -- that makes a big impact on plan pricing in and of itself. Granted, though, there's (much!) more to the ACA than just the exchanges. – Charles Duffy Jul 28 '17 at 15:31
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    The act is safer than the actual implementation of the act. – user1530 Jul 28 '17 at 17:13
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    The OP's post is ambiguous - does it mean "is the ACA here to stay" or "is the Republican Party here to stay"? Looking from the other side of the Atlantic, neither answer is obvious! – alephzero Jul 29 '17 at 16:49
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    @alephzero Given recent off-cycle election results, the democrats are probably in more trouble than the republicans. – Andy Jul 29 '17 at 18:29
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    These kind of questions are slowly turning this site into Quora. – Caleb Mauer Jul 29 '17 at 20:22
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Theoretically, the Republicans can try to repeal it again, as many times and for as long as they want - or at least until they get thrown out of office by mad voters.

In practice, the longer it's around, the more political capital will be required to repeal it, and thus the less likely it'll get repealed. Republicans standing against their own camp on grounds that their own voters might lose their insurance is a telling sign that this is occurring today.

That being said, what the administration could also do - and in fact, already started to do - is try to sabotage it in some way or another. For instance by trying to defund it somehow, by adding a few layers of red tape, etc. The point being, if they somehow manage to set things up so the ACA is almost guaranteed to look like a failure (if only by a few criteria) a few years down the road, then they could gather enough momentum to try to repeal it again when it does. (Or maybe, as Trump tweeted, it'll implode all by itself.)

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  • Comments are not for extended discussion; this conversation has been moved to chat. – Sam I am says Reinstate Monica Jul 29 '17 at 21:09
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    Some additional things that make this harder for the GOP: McCain is gone until at least August, reconciliation has a no-do-overs rule, and they still have to pass a budget, continuing resolution, and/or debt-ceiling increase at some point. All of those factors together imply formal legislative process is probably not going to happen until early-to-mid 2018 at the earliest, and by that point, midterms begin to complicate the political landscape. Trump can do various things by himself to damage the ACA, of course, but the politics of that would be... complicated, to say the least. – Kevin Jul 30 '17 at 4:50
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No, the Republicans are able to introduce further bills or amendments to repeal or replace the Affordable Care Act.

This week's vote is in fact the second attempt by Republicans at healthcare reform, after the first attempt failed in March this year due to opposition from the Freedom Caucus.

However, President Trump is able, and has already tried, to weaken some provisions of Obamacare through executive action. This article by The New York Times shows some of the actions that Trump has taken.

Additionally, Executive Order 13765, titled "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal", was signed by Trump on his first day in office that aimed to weaken regulations and procedures associated with Obamacare and called for its prompt repeal. The full text can be found here.

It directs the secretary of health and human services, as well as other agencies, to interpret regulations as loosely as allowed to minimize the financial burden on individuals, insurers, health care providers and others.

(emphasis mine)

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    Even the US military (e.g. Gen Joseph Dunford over transgender issues) is now publicly refusing to take "directions" from Trump unless they are issued as commands, not directions. Is the director of a civilian organization more or less likely to follow a "direction" to "interpret regulations" in a particular way than the miltary? – alephzero Jul 29 '17 at 16:47
  • @alephzero: It would probably result in the IRS and others backing down from somebody wanting to bring an otherwise futile legal challenge. – Joshua Jul 29 '17 at 18:50
  • @alephzero The transgender announcement was made in a tweet. The military's position that the tweet is not a binding order is at least defensible (though I'm not sure the exact rules on this). An executive order is unambiguously an... order. Executive orders still have to be legal and constitutional, but I believe they're generally followed unless/until challenged successfully in court. – Matthew Flaschen Jul 30 '17 at 9:10
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No, they will be able to attempt to repeal the ACA again in the future, but it does become significantly more difficult.

What was significant about this recent vote is that they attempted to repeal it through a process known as budget reconciliation. Reconciliation only requires a simple majority (50 votes) to pass and disallows filibustering, but they can only consider a reconciliation bill once per year.

To attempt to repeal the ACA now without waiting another year, the senate would need to go through the regular process to pass a bill. But that requires a supermajority (60 votes) which Republicans don't have, and any bill can be filibustered by democrats.

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  • Not quite. There are limits to one reconciliation bill (of each type (types are spending, revenue, and debt limit)) per budget year. But the current bill is under this budget year, fiscal year 2017. There is a new fiscal year (2018) starting October 1. They may be able to pass the fiscal year 2018 reconciliation even before then, but even if they wait until October, that's not a full year. The issue is that they wanted to use that other reconciliation bill for tax reform, so either they get health care done very soon, lose tax reform, or wait a year: goo.gl/3c15xt – Matthew Flaschen Jul 30 '17 at 9:17
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ACA is not 'safe' under any circumstances. It was already in trouble in its current form. Aetna bailed because it was losing money on the exchanges.

The NYT also chimes in with serious problems, and this was mid 2016 while the presidential campaign was well under way, with Clinton the presumptive front runner.

So the fact that the repubs couldn't agree on a replacement, and the fact that they are making the same mistake the dems made - putting together major legislation while ignoring half the country - doesn't make the current ACA 'safe'. They can try again, if they choose.

This problem won't be fixed as long as the discussion revolves around excusing one's chosen political party, while looking to slag the other. It will be solved when everyone involved makes solving the problem the main priority, regardless of who gets flamed or who gets the credit.

The chances of that happening are not good. The majority of politicians, and a good deal of citizens, are too focused on a partisan battle that no one can win.

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  • The reason for a lot of the withdrawals from the market is due to the uncertainty with Trump and the GOP. When there's no longer a guarantee of continuity, there's no compelling reason for the insurance company to gamble. So it's not entirely fair to say it was "in trouble" to the same extent pre Trump. – user1530 Aug 1 '17 at 22:35
  • That said, despite any inherent problems the ACA had, it wasn't going to just disappear. It was law and policy so it would have always come down to congress to act upon it one way or the other. Finally, I think it's also unfair to say "a majority of politicians" want a partisan battle. The ACA was a plan. The GOP congress never had a plan. So at least half the politicians at least tried to solve a problem (ironically, based off of a plan from a member of the "other team") – user1530 Aug 1 '17 at 22:38
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Firstly, it appears to me that ACA is failing on its own. Actually, when it was passed it was tremendously flawed and because of the lack of any bipartisan support, wasn't corrected before (as well as after) it went into effect. It has been withering on the vine since Obama signed it into law. The enormous price hikes and Insurer's withdrawals from the market are both signs of serious (and I expect, fatal) problems. All Trump needs to do is to direct the IRS and the DOJ not to enforce the requirement for all to be insured. I'm not clear how easily this can be done, the IRS doesn't appear to have done much to sabotage it, so far... To answer your question: I think that the Legislative Branch is going to have to eventually either drastically change it or replace it in the not too distant future. I'd guess by 2023 or 4.

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    Hi and welcome. To make this a better answer please support it with evidence rather than your opinion. Citing the serious signs would be an easy start, and I'm pretty sure others have opined similarly, linking to them would lend support. – user9389 Jul 28 '17 at 18:08
  • +1 For obamacare dying on its own, see cnbc.com/2017/06/27/… – mj_ Jul 28 '17 at 20:18
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    @mj_ I'm not sure that's evidence of "dying on its own", given that insurers have expressed significant frustration with having to set rates before knowing if the rules will be changed afterwards. Some of the big premium hikes next year are to account for the worst-case scenarios like subsidies not being paid. There are a lot of things Trump can do (and is doing) to help it collapse. – ceejayoz Jul 29 '17 at 1:16
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    The issues you point out (insurer withdrawals) have more to do with Trump than Obamacare. Had Obamacare continued on being fully supported, things would have continued on as planned. The insurers withdrawing has everything to do with the chaos that is this GOP congress. – user1530 Jul 29 '17 at 3:23
  • @ceejayoz obamacare in itself was never sustainable. the fact that trump removed subsidies only highlights the precarious nature of the plan. read this zerohedge.com/news/2017-11-17/… – mj_ Nov 17 '17 at 22:44

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