ACA repeal not on Republican agenda for 2018

The priorities for Republicans in Congress this year don’t appear to include another attempt at repealing and replacing the Affordable Care Act (ACA), though some are publicly urging the party to take another shot after several failed attempts in 2017.

As reported by both POLITICO and Fox News, Republicans said at their annual policy retreat in West Virginia they don’t see repeal as a possibility this year, having lost a seat in the Senate and having failed to mend differences within their caucus on major parts of the ACA, such as expanded Medicaid eligibility. Additionally, the party did manage to alter the law late in 2017 by repealing the individual mandate penalizing people who go uninsured as part of their tax cut legislation.

An additional procedural hurdle would also make the effort more difficult. The attempts to repeal the ACA last year used a process called budget reconciliation, limiting what changes could be made but only requiring a simple majority in the Senate, rather than 60 votes. Using reconciliation, however, requires passing a budget, which some Republicans doubt can happen quickly.

“I don’t think leadership wants to,” Sen. Bill Cassidy, MD, R-Louisiana, one of the namesakes of the last 2017 attempt at ACA repeal, the Graham-Cassidy legislation, told POLITICO. 

Cassidy’s co-sponsor on that bill, Sen. Lindsey Graham, R-South Carolina, responded to comments from his colleagues by vowing to press on with the proposal to turn the ACA’s premium support subsidies and Medicaid expansion into block grants administered by states.

He also dismissed focus on “bipartisan” proposals aimed at lowering premiums, such as additional reinsurance or renewing the cost-sharing reduction subsidies for insurers, saying “Obamacare cannot be fixed.”

“To believe that we can simply repeal the individual mandate and stop there is very naïve. The block grant approach will stop our nation’s march toward a single payer health care plan run by the federal government, and replace it with a federalist approach that will allow states to design innovative health care delivery systems,” Graham said in a statement.

Sen. Patty Murray, D-Washington, the top Democrat on the Senate health committee, said her party would welcome the move away from talks about repealing the ACA.

“It’s good news that at least some Republicans are facing reality and accepting that families don’t want any part of Trumpcare—but that won’t help people whose premiums are going up or who will lose coverage as a result of the last year of Republican health care sabotage,” Murray said in an e-mail to HealthExec. “If Republicans are really serious about turning the page, they’ll start working with Democrats to undo the damage they’ve done and focus on what families do want—lower health care costs and better coverage.”