Can the Affordable Care Act Really be Repealed?: Page 2 of 2

July 14, 2016

ACA’s Soft Spots for Republicans to Target

Assuming the ACA is here to stay, which, if any, of the Ryan provisions are likely to see the light of day?

To answer this question, Mr Smith goes back to CMS’s recent call to shorten lengthy enrollment periods. “Under the Ryan plan you can’t just drop coverage when you get better,” he says. “[Limiting that] has value.” 

Similarly, allowing states to require able-bodied recipients to work, as well as to alter premiums and coverage for certain beneficiaries, “also makes a lot of sense,” explains Mr Smith. “Some people in California are making $93,000 annually and qualifying for MediCal.” He warns, however, that making this change will be challenging and might be perceived as racially discriminatory. 

Dr Spivack thinks the Republican strategy of offering repeal as an opening salvo, but settling for an unbundling of certain provisions, sounds reasonable—“as long as what’s unbundled doesn’t irreparably ruin the law from a financial, sustainability, or benefit perspective.” 

It might be best for Republicans to focus on creating a universal benefit package that serves as a “basic plan that would hopefully be less costly and allow healthier individuals to sign up for coverage,” says Dr Owens. “Get rid of the metallic-level plans in favor of one base plan, and then allow the carriers to offer appropriate buy-up options.”


What Should Be Left Alone

Mr Smith agrees with Dr Spivack that Republicans need to pick the right provisions to modify. “If you change certain aspects it will blow up the whole thing. For one, you’ve got to have everyone in the [insurance risk] pool,” which makes removing the mandate problematic. 

Selling across state lines sounds reasonable, until you consider how long it will take to cut through the state bureaucracies, he explains. “The insurance commissioners would be giving up their turf, which is not something they’d be willing to do easily.” 

And then there is the idea of raising the age of Medicare eligibility, which many believe is politically unwise. It seems a risky move in the face of the baby-boomer base and a powerful AARP lobby. Still, Mr Smith thinks the Republicans have a chance of getting it through. 

For one, they’re only asking for the Medicare eligibility age to match that of Social Security. Plus, there is precedence: the US Congress raised the retirement age in the 1980s. “People are living longer, so it makes sense to raise the age” when people become eligible for Medicare, says Mr Smith. 


What Lies Ahead for the ACA

In the end, “the future very much depends on the election,” explains Anthony Morreale, PharmD, assistant chief consultant for clinical pharmacy services and health services research, Department of Veterans Affairs. The Ryan plan “is simply a framework to start negotiations. If the Democrats don’t take the White House and the Republicans maintain control of the House and Senate, then I think there is a real chance of reforming the existing plan.”