Things are shifting right now on Capitol Hill with regard to Republicans’ previously stated intentions to “repeal and replace” the Affordable Care Act (ACA), often referred to as “Obamacare,” with key Senate Republicans changing their tone, and their pronouncements, on what might happen next. The ACA has been in place since March 23, 2010, when President Barack Obama signed it into law. A focus of Republican opposition ever since then, the ACA became a significant focus of the 2016 presidential election campaign, as Donald Trump and other Republicans vied with one another during the Republican presidential primaries over who might most effectively repeal the law.
President Donald Trump has weighed in, signing two executive orders that are connected to healthcare policy. First, on Jan. 20, just hours after taking the oath of office, President Donald J. Trump signed an executive order, one of his first, giving federal agencies the authority to work within their scope of authority to undo unspecified regulations pertaining to the Affordable Care Act (ACA) of 2010. Exactly how such authority might be used, and under what circumstances and to what extent, was left extremely unclear; but the order did signal Pres. Trump’s previously stated intentions to help to overturn the ACA, though only the U.S. Congress can actually fully repeal the legislation. A second executive order directing a freeze on new regulations pending review, could also impact elements around how the ACA’s regulations might evolve forward.
The first of the two orders directs the Secretary of Health and Human Services (HHS) to work within their scope of authority to undo ACA-related regulations. To some extent, that order awaits the confirmation of Rep. Tom Price of Georgia, whom Trump has nominated as the next Secretary of HHS, but whose nomination has slowed as it has worked its way through the Senate. On Feb. 1, in the face of a boycott of a committee vote by Senate Democrats, Senate Republicans used a procedural maneuver to push the Price nomination out of Senate Finance Committee and forward into the full Senate for a vote. Rep. Price has said that he fully supports repeal and replacement of the ACA, and that as Secretary of Health and Human Services, he plans to assist congressional Republicans in repealing and replacing it.
Now comes a shift in the tenor of the discussion on Capitol Hill. On Thursday, Feb. 2, Kelsey Snell and Mike DeBonis of The Washington Post reported that “Two top Republicans long expected to lead the Senate’s role in repealing the Affordable Care Act said publicly this week that they are open to repairing former president Barack Obama’s landmark health-care law ahead of a wholesale repeal, which has been a GOP target for eight years. Coming one week after a closed-door strategy session in which Republicans expressed frank concerns about the political ramifications of repealing the law and the practical difficulties of doing so, statements this week by Sen. Orrin G. Hatch (R-Utah) and Sen. Lamar Alexander (R-Tenn.) brought into public view the political and policy challenges the GOP is facing,” Snell and DeBonis wrote.
Snell and DeBonis reported on statements made by Sens. Hatch and Alexander, who are the Chairmen of the Senate Finance Committee (Hatch) and of the Senate Committee on Health, Education, Labor and Pensions (HELP; Alexander), respectively, in their story published on Thursday. Those are the two Senate committees that would be responsible for any significant legislative effort to overturn the ACA in whole or in part. In a hearing Wednesday, Alexander said, “I think of it as a collapsing bridge…. You send in a rescue team and you go to work to repair it so that nobody else is hurt by it and you start to build a new bridge, and only when that new bridge is complete, people can drive safely across it, do you close the old bridge. When it’s complete, we can close the old bridge, but in the meantime, we repair it. No one is talking about repealing anything until there is a concrete practical alternative to offer Americans in its place.”
And Hatch, chairman of the Senate Finance Committee — another panel with a crucial role in the effort to repeal the ACA — said Thursday that he “could stand either” repealing or repairing the law. “I’m saying I’m open to anything. Anything that will improve the system, I’m for,” he said.
As Snell and DeBonis noted, “The comments come one month after Republicans in Congress first set out to immediately repeal and replace the Affordable Care Act. While an increasing number of them have expressed concern about how feasible it is, many others, including House Speaker Paul D. Ryan (R-Wis.), remain committed to a wholesale repeal and replacement.” They quoted a statement that Rep. Ryan had made in an appearance Thursday morning on “Fox & Friends,” a Fox News program, in which he said, “There’s a miscommunication going on. If we’re going to repair the U.S. health-care system… you must repeal and replace Obamacare.”
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