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Affordable Care Act 'Repeal and Replace': A Political Autopsy

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The resurrected, failed and most likely final attempt at an Affordable Care Act repeal effort in the Senate was operating under a very tight timeframe to get a vote on the Senate floor before the end of September, so that it could pass with a simple majority vote and not have to be subject to filibuster.

But, the Graham-Cassidy plan was still facing many of the factors that defeated earlier attempts. There were no Democrats who would support the measure, and in addition to opposition from Sen. Paul Rand, the same trio of Senate Republicans that have held out in the past, McCain, Murkowski, and Collins, indicated they would not vote yes for this plan either. Compounding the problems for this attempt was the fact that not even one medical, insurance or consumer group would come out in favor of this plan and most vocally expressed their continued opposition.

(Related: Republicans Put Off Graham-Cassidy Vote)

The “Graham-Cassidy plan” focused on capping Medicaid spending and shifting to a block grant model in the states. This model would provide a fixed amount of money to each state and then give them decision-making authority on how it is spent. 

What sparked so much opposition is a combination of the millions of people that would most likely lose coverage from less Medicaid dollars and more restrictions at the state level to eligibility of coverage. Also, pre-existing coverage protections would be endangered having a particularly harsh impact on those most in need of health care.

What is so interesting is that the underpinnings of the Affordable Care Act is the expansion of Medicaid which led to the coverage of millions of previously uninsured people.

This had the effect of turning funding for Medicaid into the new “third-rail” of politics.

Before the Affordable Care Act, Medicaid didn’t really have a constituency to defend it. Today it has a a very powerful coalition of defenders and those that dare to challenge this group by taking away funding and coverage do so at their own risk.

It’s important to recognize the fact that Medicaid is the nation’s primary payer for long-term care services, in the same way that Medicare is the nation’s payer for hospital and doctor visits for anyone over the age of 65, and it now has considerable support protecting the program. To create fiscal balance, more must be done to educate and incentivize people to use private pay resources for long-term care. Tax incentives to purchase long-term care insurance, save for future long-term care costs, and repurpose assets, such as exchanging life insurance policies for tax-free long-term care benefit accounts, are examples of how people could be less reliant on Medicaid.

It is said that a nation’s healthcare system is a reflection of its values. The fundamental debate that once again is underway still boils down to which side of this question are you on: Is health care a right or a privilege and how do you ensure people are obtaining coverage through incentives or mandates? In many way these are the questions that divide our nation into Red or Blue states and have been argued amongst our citizens since 1776.

—-Read Lamar Alexander Puts Bipartisan ACA Repair Bill Back in Play on ThinkAdvisor.

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