- A small group of Republican lawmakers released a new version of legislation to repeal the Affordable Care Act (ACA) on Wednesday. It would repeal the individual and employer mandates and promote the use of health savings accounts. The bill would also end Medicaid expansion and change the program's funding to a block grant system with per-capita caps.
- Meanwhile, Sen. Bernie Sanders (I-.Vt.) announced his Medicare-for-all plan, which has the support of more than a dozen Democrats.
- Lawmakers also said they have come to a bipartisan agreement for reauthorizing the Children’s Health Insurance Program (CHIP), which needs continued funding by the end of this month.
Healthcare isn’t going away as a hot topic of discussion on Capitol Hill. While the chances of approving either the latest ACA repeal bill or a Medicare-for-all plan are practically nonexistent, the two proposals offer a look at what each party's desires are in changing the country’s healthcare system.
Republicans are pushing for greater control of healthcare policy at the state level. While Democrats aren't necessarily opposed to the concept, they see overreach in letting states ignore the ACA’s essential health benefit requirements and impose more restrictive Medicaid qualifications.
The latest repeal plan is similar to the bills that failed in dramatic fashion in late July. It doesn’t have immediate outright cuts to Medicaid, but the change in how the program is funded would result in a reduced budget. The Congressional Budget Office has not yet released a score of the latest proposal, but the agency predicted earlier legislation with many of the same provisions would lead to about 20 million people losing health coverage.
Much of that stems from a key element in nearly all the GOP proposals — a fundamental restructuring of the Medicaid program. It would be funded with block grants where states would receive a set amount of money based on the number of beneficiaries. An analysis of the bill from the Center on Budget and Policy Priorities estimates the block grant approach would lead to $239 million less in federal Medicaid funding between 2020 and 2026.
The idea of repealing the ACA won't die at the Capitol, but several lawmakers have said they highly doubt a repeal bill will approved by the Sept. 30 deadline.
Similarly, Sanders’ plan is an extreme long shot for becoming law anytime soon, but it could launch a discussion about the practicalities of a single-payer health system in the U.S. Sanders has long sought a single-payer plan, but has rarely given details of what such a plan would entail. The fact that the plan now has a number of co-sponsors — including potential presidential candidates such as Cory Booker, Kamala Harris and Elizabeth Warren — shows that single-payer healthcare could become a core plank of the Democratic party's platform going forward.
The plan released Wednesday would create a universal, government-funded plan, eliminate deductibles and most co-pays, and bar employers from offering competing health plans. People in Medicaid and Medicare would transition to the new plan and those programs would be ended.
The biggest question mark for the plan is how it would be paid for. Sanders has listed a number of potential ways to finance it, but hasn’t talked much about how the numbers would sort out. That would be a major sticking point in any realistic discussion of single-payer healthcare.
Last but not least, the agreement on CHIP funding — while not final — is welcome news for the healthcare industry. The bipartisan plan would extend the program for another five years.