Congress taking steps toward Obamacare repeal as state prepares to react

In a marathon session, the U.S. Senate rejected 19 health care-related pieces of legislation Wednesday and Thursday, culminating in a budget resolution that sets the stage for repealing Obamacare. Now the action moves to the House and, eventually, state capitols.

The evening, known by some as “vote-a-rama,” ended at 12:05 a.m. CST with a 51-48 vote on a resolution that sets forth the budget for fiscal year 2017 and sets budget levels for fiscal years 2018-26. Republicans are using the budgetary process to begin the repeal of the Affordable Care Act (ACA) because it requires only a majority vote.

Arkansas’ two U.S. senators, Sen. Tom Cotton and Sen. John Boozman, voted for the bill, which passed along party lines with only Sen. Rand Paul, R-Kentucky, voting against it. Paul has said the resolution did not create a path toward a balanced budget.

Many of the failed measures were pushed by Democrats and meant to draw a contrast with Republicans on health care reform. Others were pushed by Republicans but failed to achieve the necessary super-majorities.

The votes started with an amendment at 5:21 p.m. CST on a bill that, among other provisions, would prevent the Senate from considering “any legislation that makes America sick again,” such as by reducing the number of Americans with health insurance. It failed along party lines, 47-51, with both Cotton and Boozman voting no. At 9:26 p.m. CST, the Senate rejected a Democratic amendment meant to prevent legislation that would eliminate or reduce federal funding to states that have expanded their Medicaid populations, which includes Arkansas. It failed, 48-50, with both Cotton and Boozman voting no.

The one measure that did not fall along party lines was an amendment that would have established a reserve fund to import drugs from Canada. It failed, 46-52, with 12 Republicans including Boozman voting yes and 13 Democrats voting no.

Now the budget measure moves to the House of Representatives, which is scheduled to vote Friday on its own budget resolution that would begin the repeal of the ACA.

Passage would not mean repeal is certain. While Democrats are united in protecting the law, Republicans are divided into two camps – those who favor an immediate repeal with a replacement to come later, and those who argue that Republicans must present a replacement at about the same time the ACA is repealed.

Proponents of the second tactic include President-elect Donald Trump and Cotton. In an interview with Talk Business & Politics set to air Sunday, Cotton said he could vote for replacement pieces that occur “in relatively short order” after repeal.

“What we should not do is wait until 2018 or 2019 to try to reach a solution,” he said. “Health care is a very complicated problem. It’s been made worse by Obamacare. We’re not going to find the answer any easier a year or two years from now.”

In the House, the conservative Republican Study Committee has introduced a replacement plan, the American Health Care Reform Act of 2017, which would repeal Obamacare and go into effect Jan. 1, 2018. The bill creates a standard $7,500 tax deduction for individuals with health insurance along with a $20,500 deduction for families. It also would expand federal support for state high-risk pools for Americans with pre-existing conditions, while capping premiums at 200% of the state’s average premiums. It also would allow insurance to be sold across state lines while allowing small businesses to create pools to negotiate for better rates.

U.S. Rep. French Hill, R-Little Rock, an original co-sponsor of the AHCRA, said in an after-hours speech on the House floor Wednesday that the act would empower “patients, not politicians.” He said the ACA has increased costs, burdened businesses and led to more part-time jobs.

Hill said Arkansans have seen smaller premium price increases on health insurance exchanges because of the program now known as Arkansas Works, which uses federal Medicaid dollars to purchase private insurance off the exchanges.

Hill referenced a six-page letter from Gov. Asa Hutchinson along with Allen Kerr, the state’s insurance commissioner, to the House leadership dated Jan. 10. In the letter, Hutchinson asked that states be allowed to set Medicaid eligibility at levels below 138% of the federal poverty line and that states be allowed to make Medicaid more of a temporary benefit through work requirements and other means. He also repeated a call for some federal Medicaid funding to be delivered through block grants, with the state using the money as it sees fit.

“We do not merely seek flexibility within a federal regulatory framework; we seek the freedom to again fully exercise our roles and responsibility to regulate the health insurance industry,” Hutchinson wrote.

Hutchinson also called for:
– Abolishing the Center for Consumer Information and Insurance Oversight “as there is no need for a national insurance commissioner”;
– Ending the federal insurance exchange;
– Ending federal individual and business mandates to buy insurance and leaving those requirements up to states;
– Eliminating federal essential health benefits requirements, allowing states to tailor coverage;
– Using federal tax credits to promote coverage;
– Restricting the federal Centers for Medicare and Medicaid Services regarding rate reviews and plan filings that are being performed by state regulators;
– Eliminating duplicative federal collection of data that is already being collected by the states;
– Allowing health insurance to be purchased across state lines;
– Integrating Medicaid and other public assistance programs such as workforce development and housing;
– Allowing small businesses to create associations offering health insurance, including across state lines.

Hutchinson said the state could react to changes at the federal level quickly, writing, “We are confident that we can adjust to the repeal of the ACA within 90 days and do not foresee any need for a lengthy transition period.”

His spokesman, J.R. Davis, clarified in an email that Hutchinson was referring to the act being repealed and replaced.

Senate Majority Leader Jim Hendren, R-Gravette, said legislators do not anticipate having to react to any changes to the law before they recess from their legislative session, which typically ends in April. Either the law will still be in the process of being repealed and replaced, or there won’t be enough clarity in time for lawmakers to respond.

“It’s the first step in a long journey to unwind this thing. I think they’re going to find it’s a whole lot easier to take those first few steps than it is to get all the way to the end of the path,” he said.

A special session regarding health care is possible later in the year, Hendren said. In the meantime, the Hutchinson administration will be seeking Medicaid waivers from the Trump administration.