Close Close

Life Health > Health Insurance > Your Practice

ACA repeal efforts are off to a disappointing start

Your article was successfully shared with the contacts you provided.

As I write this, the 115th Congress of the United States has just gaveled itself to life.

The Republicans have been coming to the House floor and the Senate floor to hack away at that wicked Obamacare. Democrats have used their floor time to defend the saintly Affordable Care Act.

Related: ACA exchanges, health insurers and public perceptions

Republican senators and representatives typically talk about an individual constituent back home who’s facing higher health insurance premiums, or a business owner who’s facing horrible reporting headaches, because of Obamacare.

Occasionally, Republicans talk about returning to the joys of a pre-ACA world, in which consumers would get all of their health insurance consumer protections from state insurance laws and the federal Health Insurance Portability and Accountability Act of 1996, with fine new subsidized risk pools for people with diabetes or cancer. The promoters of the return to risk pools tend to leave out the part about how many of the pre-ACA risk pools were underfunded. Sick people often had to wait for years, without coverage, to get into the risk pools.

Some early Republican proposals for replacing the ACA call for repealing all of the main part of the ACA package, the Patient Protection and Affordable Care Act of 2010, and all of the health parts of PPACA’s little sister, the Health Care and Education Reconciliation Act of 2010.

Democrats, meanwhile, put up pictures of people with diabetes or cancer, and imply that they’ll die, or at least suffer misery, if the ACA goes away.

Democrats rarely admit that any specific part of the ACA (other than, occasionally, a part of the ACA that the unions or technology companies back home happen to hate) has any specific flaw. They’ll merely acknowledge that the law has vague problems — to be named later — that need to be worked on.

When I watch members of Congress debating the health law, I feel like a book fan, watching a new movie with the same name as my favorite book, who has discovered that the filmmakers bought the rights to the story but have actually read the book.

Republicans blast, and Democrats defend, the parts of the ACA that created what most people think of as “Obamacare”: the ACA individual and employer coverage mandates; the ACA employer coverage reporting rules; the ACA public health insurance exchange system; the subsidies that help exchange plan users pay for coverage and the Medicaid expansion subsidy program; and, occasionally, the ACA major medical coverage standards.

The gladiators never mention these non-Obamacare parts of PPACA:

            • Section 2004: Makes Medicaid available to former foster children.

            • Section 2402: Removes barriers to providing Medicaid-paid long-term care services in the home.

            • Sections 2405: Expands support for State Aging and Disability Resource Centers.

            • Section 4102: Supports oral health care prevention activities, including efforts to put sealant on children’s teeth.

            • Sections 5201 through 5311: Seeks to expand the supply of health care workers, by, for example, providing grants for geriatric care professional training programs.

            • Section 6103: Creates Medicare’s nursing home comparison website.

            • Section 6121: Promotes dementia and nursing home aide abuse prevention training.

            • Sections 10608: Expands access to medical malpractice for employees or contractors working at free health care clinics.

On the one hand, some of these sections might have created boondoggles.

On the other hand, who really wants to reduce former foster children’s access to Medicaid or kill off geriatric care training programs? I think the fact that many proposals for replacing the ACA simply cancel all of PPACA and the health parts of HCERA suggest that the repeal drafters have limited familiarity with the text of either law.

On the third hand, the bottom line seems to be that lawmakers are just as lost as any of your private-sector health insurance planning clients. They desperately need your help, and the help of your trade groups, with understanding what the law says; how the ACA world really works, and fails to work; and how to change the health care system based on experience with the real world, rather than talking points about saints and demons.

Allison Bell is a senior editor at National Underwriter Life & Health.


Republicans forge ahead with ACA change efforts

ACA change rules

We’re on Facebook, are you?