ACA Faces A Chicken-And-Egg Dilemma

By Susan Rupe

The future of the Affordable Care Act appears to be more like the age-old question: Which came first – the chicken or the egg? Only in this situation, the question is more like: Which comes first – repeal or replace?

Repeal? Or replace? It depends on whom you ask.

The Republicans in Congress seem headed for a full-out repeal of the ACA – or at least on bringing repeal up for a vote fairly soon in the new term. That was the word from House GOP leaders earlier this week.

But repeal would be the easy part. There are enough votes in a Republican-controlled Congress to send a repeal measure to the new president for approval. Voting to do so early in the new term would send a message to voters that Republicans intend to deliver on a promise they proclaimed in every campaign speech made during this most recent election cycle.

After repealing, lawmakers next need to answer the question: With what? That’s where things get tricky. Approval of a replacement plan would require Senate Republicans to get some of their Democratic colleagues on board as the GOP does not have the required 60 votes in the Senate to get such a measure passed.

Then the issue becomes a matter of deciding what aspects of the ACA are worth keeping, what aspects need to go, what the new law would look like and whether it would accomplish the goal of obtaining coverage for Americans while keeping costs down.

House Majority Leader Kevin McCarthy said earlier this week that it’s possible Congress could vote on a repeal but put off the date for that repeal to take effect. This would buy time while both parties work out a replacement plan.

Meanwhile, Congress might be well advised to look at a recent Kaiser Family Foundation poll that showed Americans are more concerned about the cost of prescription drugs than they are about the health care law itself. Of those polled, 74 percent said they believe the highest health-care priority for Congress and the new president should be improving the affordability of drugs to manage chronic conditions such as HIV, cancer and hepatitis. Only 37 percent said the top priority should be repeal of the ACA.

Americans also are divided on what the next steps should be where the ACA is concerned. Kaiser’s poll found that a nearly equal percentage want to repeal the law versus expand it. Nearly one-third of those polled (32 percent) want the law to be repealed while 31 percent want to see it expand. Eighteen percent want to see the law move forwarded as it is and 9 percent want to see the law scaled back.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].