McConnell says Obamacare will have to be replaced gradually

The Patient Protection and Affordable Care Act will be replaced “in a phased-in way over a period of time,” not right away, Senate Majority Leader Mitch McConnell said Saturday.

“You can’t just snap your fingers and go from where we are today to where we’re headed,” McConnell told the Kentucky Farm Bureau Federation at its annual meeting in Louisville. “This has to be done carefully.”

Sen. Mitch McConnell spoke at the annual Farm Bureau meeting Saturday. (Photo by Ry Barton, WFPL)

“This emerging ‘repeal and delay’ strategy, which [House] Speaker Paul D. Ryan discussed this week with Vice President-elect Mike Pence, underscores a growing recognition that replacing the health care law will be technically complicated and could be politically explosive,” report Robert Pear, Jennifer Steinhauer and Robert Kaplan of The New York Times.

Bruce Schreiner of The Associated Press paraphrases McConnell as saying: “Congress will begin work immediately next year toward repealing President Barack Obama’s health-care law but delay the changes as Republicans try to come up with an alternative,” something they didn’t have to do when they passed repeal bills because they knew Obama would veto them.

McConnell “insisted that some 20 million Americans who have health care through the six-year-old law will not lose coverage, though the likely upheaval in the insurance industry suggests many could,” Schreiner reports.

“President-elect Donald Trump says he would like to keep major elements of the law — allowing children to remain on their parents’ plans until age 26 and ensuring companies don’t deny coverage for pre-existing conditions. But it’s unclear how a new version of the law could force insurance companies to provide the latter coverage.”

One way to do that would be to keep the law’s requirement that all Americans buy health insurance, an idea that many Republicans favored before Obama was elected but opposed when he pushed the law through Congress with only Democratic votes. A possible alternative would be to keep the requirement but allow younger people to buy cheaper policies with thinner coverage.

The details of that will wait, as Republicans push a repeal bill through the House and the Senate, in the latter under budget-reconciliation rules that will prevent Democrats from blocking it with a filibuster. “The health law includes insurance market standards and other policies that do not directly affect the budget, and Senate Republicans would, in many cases, need 60 votes to change such provisions,” the Times notes.

The “repeal and delay” approach “is meant to give Mr. Trump’s supporters the repeal of the health law that he repeatedly promised at rallies,” the Times reports. “It would also give Republicans time to try to assure consumers and the health industry that they will not instantly upend the health insurance market, and to pressure some Democrats to support a Republican alternative.”

Unwinding the law “could be as difficult for Republicans as it was for Democrats to pass it in the first place and could lead Republicans into a dangerous cul-de-sac, where the existing law is in shambles but no replacement can pass the narrowly divided Senate. Democrats would face political pressure in that case as well,” the Times reporters write. “It is not sheer coincidence that at least one idea envisions putting the effective date well beyond the midterm congressional elections in 2018.”

Tennessee Sen. Lamar Alexander, chair of the Senate health committee, told the Times, “I imagine this will take several years to completely make that sort of transition — to make sure we do no harm, create a good health care system that everyone has access to, and that we repeal the parts of Obamacare that need to be repealed.”

However, the Times reporters write: “Health policy experts suggest ‘repeal and delay’ would be extremely damaging to a health care system already on edge. “The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University, told the Times. “Insurers need to know the rules of the road in order to develop plans and set premiums.”

The Times reports, “Any legislation is likely to include elements on which Republicans generally agree: tax credits for health insurance; new incentives for health savings accounts; subsidies for state high-risk pools, to help people who could not otherwise obtain insurance; authority for sales of insurance across state lines; and some protection for people with pre-existing conditions who have maintained continuous coverage.

“Republicans said they hoped that the certainty of repeal would increase pressure on Democrats to sign on to some of these ideas.

Democratic leaders, for now, feel no such pressure. Republicans ‘are going to have an awfully hard time’ if they try to repeal the health law without proposing a replacement, said Sen. Chuck Schumer of New York, the next Democratic leader. ‘There would be consequences for so many millions of people.'”

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