In the most concrete statement made so far by a Republican member of Congress who is in a formal leadership role on healthcare legislation, Sen. Lamar Alexander (D-Tn.) gave an interview to Talking Points Memo on Wednesday in which he expressed his determination to develop replacement legislation for the Affordable Care Act (ACA), to make sure that the tens of millions of Americans who rely on the federal health insurance exchanges under the ACA, before repealing it. The question of what do with the ACA has become a central focus of Republicans in both the U.S. Senate and the U.S. House of Representatives, following the November elections.
Sen. Alexander, the Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN), who has long advocated for a "simultaneous" approach to scrapping and replacing the Affordable Care Act, told Talking Points Memo’s Lauren Fox that Republicans should be focused on repairing Obamacare's exchanges while building a new system to deliver health care to the American people. Alexander only wants to see Obamacare repealed once "there are concrete, practicable reforms in place." "It's not about developing a quick fix. It's about working toward a long-term recovery that works for everyone," Alexander said.
Alexander went on to tell the Capitol Hill-focused publication that he wants to first "rescue" the current Obamacare exchanges because people are still on them. "First we'll offer a rescue planning so that the 11 million Americans who buy insurance how on the exchanges can continue to do so while we build a better set of concrete, practical alternatives,” he said. To do that, Alexander wants "Congress and the president to take action before March 1, which is when insurance companies begin to decide whether they will offer insurance on these markets during 2018. In general, the goal is to get as close as possible to allowing any state-approved plan to count as health insurance under Obamacare rules while we are transitioning to a new system."
During the transition, Alexander told Talking Points Memo, Republicans should continue the cost-sharing subsidies that insurers get for covering low-income people on the exchanges. He also advocated "repeal [ing] the individual mandate when new insurance market rules are in place" and giving individuals the opportunity to use their Obamacare subsidies to purchase health insurance outside of the Obamacare exchange.
Alexander went on to tell the publication that, once new insurance market rules are in place, Republicans would then go to work on building a new health care system. "I say systems, not one system,” he said in the interview. “If anyone is expecting Senator McConnell to roll a wheelbarrow on to the Senate floor with a Republican health care plan they're going to be waiting a long time because we don't believe in that. We don't want to replace a failed Obamacare federal system with a failed -- with another failed federal system. We want to create many systems across this country step by step ... we'll do this by moving more health care decisions out of Washington and into the hands of states and patients." And, he added that, in replacing the ACA, changes would not touch Medicare, nor would the replacement legislation take away protection for people who have pre-existing conditions. The replacement would also allow people to stay on their parent's plans until they're age 26. One of the core challenges Republicans in Congress are facing is that of attempting to retain such popular features as protection for people with pre-existing conditions and for adult children up to the age of 26, while at the same time not causing damage to the individual health insurance market.
Whether or not President-elect Donald Trump was aware of Alexander’s statements to Talking Points Memo on Wednesday morning was not clear. Trump said in a press conference Wednesday morning that repeal and replacement of the ACA would take place “almost simultaneously”; but he also said that it would happen very quickly, based on a plan that would emerge from his administration, once his nominee for Secretary of Health and Human Services, Rep. Tom Price (R.-Ga.) was approved by the Senate. Confirmation hearings for Rep. Price will begin next Wednesday, Jan. 18, in the HELP Committee.
Healthcare Informatics will continue to update readers on this evolving situation.