The number of insurers participating in the Obamacare marketplaces is falling. This year, 182 counties had only one insurer offering plans. Next year, that will be true of nearly 1,000 counties, or almost one-third of the total. An average marketplace will offer 17 fewer plans in this fall’s open-enrollment period than last year’s. Fewer choices make it harder for consumers to find plans that meet their needs, like including doctors and hospitals they prefer and covering the drugs they take.
When the new Congress and President-elect Trump take office in January, Republicans will have a real chance to repeal President Obama’s Affordable Care Act. If they succeed, it will be the result of their carefully executed strategy to repeal the law and repeated congressional votes to do so. This approach was the subject of much derision from Democrats, but sticking to it has now put the Republicans in a position where they can reach their goal.
According to the Congressional Research Service’s review of the current legislative calendar, the 115th Congress seated in January 2017 will have a chance to review any rule issued after May 16, 2016. If the new Congress resolves to disapprove any of those regulations, President Trump will be the one to sign or veto that resolution. Our analysis suggests that more than 150 significant rules published since mid-May could be subject to CRA disapproval next year , as well as any new regulations issued between now and January 20, 2017.
In return for letting those bills reach the floor, Paul Ryan was promised Trump’s backing for an omnibus health care bill replacing Obamacare and reforming Medicare at once. But as health care negotiations dragged on across 2017, it became clear that Trump was quietly encouraging a tacit right-left grass-roots alliance against benefit cuts of any sort.
This came to a head in what was dubbed “the Battle of Janesville,” when Ryan found himself shouted down by a crowd of town hall seniors, some sporting “Make America Great Again” caps, as he tried to defend Medicare premium support. After that scene (which played over and over on Sean Hannity’s nightly propaganda hour) Ryan’s vision withered on the legislative vine — leaving Obamacare to limp on, its subsidies officially repealed but “temporarily” extended every year.
Last year, Congress failed to pass a budget for fiscal year 2017, creating an opportunity for Congress to pass two budgets next year, rather than just one. This gives Republicans two shots at getting filibuster-proof reconciliation bills to Trump.The first budget is simple. The spending and tax levels include one assumption: The ACA is repealed. That ACA repeal budget should also include instructions to the relevant committees in Congress. Congress should be able to easily pass a budget resolution with these criteria with simple majorities in each chamber and begin the process of work on the reconciliation bill before Inauguration Day. This will set up the ability for Congress to pass a reconciliation bill repealing all the budgetary components of the ACA immediately after Trump is sworn into office.
The House Republican Plan (“A Better Way”) released on June 22, 2016, includes a proposal to convert federal Medicaid financing from an open-ended entitlement to a per capita allotment or a block grant (based on a state choice).1 This proposal is part of a larger package designed to replace the Affordable Care Act (ACA) and reduce federal spending for health care. Often tied to deficit reduction, proposals to convert Medicaid’s financing structure to a per capita cap or block grant have been proposed before. Such changes represent a fundamental change in the financing structure of the program with major implications for beneficiaries, providers, states and localities.
House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell agree that repealing and replacing the Affordable Care Act is a top priority under the incoming Trump administration, but appear not to be in full agreement on how to do so.