An Affordable Care Act Update: Can the Republicans Really Reform It?

Abstract

In a recent discussion in Health Affairs, Jost (2017) discussed a possible version of the Republicans’ proposal for replacing the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). In mid-January, the House and Senate adopted a budget resolution that required the reporting of “repeal” legislation by January 27 that could be incorporated into a reconciliation bill passed by simple majority vote. However, the Congressional Budget Office provided evidence that repeal alone would be a disaster, and the focus shifted to replacement. There are now several proposals in Congress that still need reconciliation with the Trump administration's plans for reform. In addition to the Patient Freedom Act (S. 191, 2017) (proposed by senators Cassidy [R-LA], Collins [R-ME], Isakson [R-GA], and Capito [R-WV]), several other replacement plans were introduced in Congress in early 2017 by Republican leaders, including Speaker Paul Ryan (R-WI), Health and Human Services Secretary-designee Rep. Tom Price (R-GA), Senator Rand Paul (R-KY), and others. Although they are different in approach, all incorporate a philosophy similar to the Patient Freedom Act and share the following key components: ...