Death by Two Tweets… The GOP and ACA

Late Monday night both Republican Senators Mike Lee of Utah and Jerry Moran of Kansas tweeted that they would not support the Senate’s version of the Better Care Reconciliation Act (BCRA) and therefore stymied Congress from getting the bill to President Trump’s hands for signature.

Ironic or soothing that the man who graces us with 140 characters of chicken soup for the soul learns publicly with the rest of the world of the grim status of one of his biggest promises.

To no avail, Mr. Trump was back to Twitter shortly after calling for a complete repeal of the Affordable Care Act (ACA) stating that, “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”

What this means for us and what a “REPEAL” would likely mean for the American public:

1) Twitter is the official podium of all credible politicians—don’t think about it too much.

2) For now the Affordable Care Act is here to stay.

3) What is this repeal they now speak of? Because the BCRA will not make it through the Senate the last attempt of the GOP is to vote to repeal the ACA in its entirety and rebuild or “replace” the bill in the future.

However, given the budgetary reconciliation rules a repeal at this point would only impact the measures of the bill directly relating to financial/budgetary matters.

For example, a repeal would take away the individual mandate that everyone, healthy or sick, buy insurance. However, the obligation that insurance carriers write policies for anyone, no matter their health status, would not be touched.

This creates a dynamic that Larry Levitt, Vice President of the Kaiser Family Foundation, a health care research organization, addressed this morning on the radio. He stated that, “Insurers would have to take people with pre-existing conditions, but the sense is that healthy people without that mandate wouldn’t sign up… So insurers, with that kind of uncertainty, would immediately raise rates.”

An immediate repeal without any immediate corrections would undoubtedly cause more turmoil in the insurance markets and thus negatively impact premiums and the majority of those buying health insurance on the public exchanges.

4) For employers, an immediate repeal would also take away the corporate mandate and associated penalties but would not address anything related to ACA reporting, credible coverage requirements, age limitation or other aspects of the ACA that impact the actual medical care for employees.

Let’s be honest, the majority of companies above 50 employees (Applicable Large Employer status) were already offering coverage to their employees prior to the advent of the Affordable Care Act. Very few would have to wrestle with taking away a benefit that employees have come to expect and appreciate.

All in all, this proves once again that once a “benefit” is given to the American voters it is difficult to take it away—but didn’t FDR’s new deal teach us this in the 1930s?

We at Bolton have been diligently following this conversation all spring. I wrote in January before the first version of the House bill that, “Right now we wait. And while we wait we do. Just as in life.”

Thanks for waiting and doing with us.


About Rob Boldt

Rob Boldt consults with for-profit and nonprofit businesses on ways to provide health insurance benefits that are cost effective, and increase overall employee satisfaction. He helps clients to understand the latest industry trends in health care, compliance, and HR technology systems. He is also a true collaborator who believes in making work fun. Connect with Rob on Twitter @boldtme and LinkedIn.

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