Baby taking first steps

On March 7, 2017, Speaker of the House Paul Ryan (R-WI) detailed the Republican plan for Obamacare repeal during his weekly news conference. He outlined a three-phase effort.

Phase 1: Pass the American Health Care Act.

Phase 2: Cut down regulations, lower costs, and stabilize the health insurance marketplace with administrative acts.

Phase 3: Pass more legislative policies that would include other Republican-backed healthcare reform proposals.

Read on to find out more about Ryan’s three phases of Obamacare repeal.

Phase 1: The American Health Care Act

The American Health Care Act (AHCA) is a bill introduced by the House of Representatives. Much controversy surrounds this bill. According to Ryan, the bill’s driving principles are to ensure “lower costs, more choices not less, patients in control, [and] universal access to care.” This bill seeks to utilize budget reconciliation in order to start the first phase of Obamacare repeal.

What is budget reconciliation and why is it important in this case? Republicans hold a majority of the seats in Congress, but they only have 52 out of 100 seats. In order to repeal Obamacare, Republicans will have to come up with legislation that could overcome a filibuster by Democrats. In order to end a filibuster, which prevents votes on bills from occurring, supporters of the bill would have to obtain 60 votes. It’s expected that obtaining 60 votes in the Senate to end a filibuster will be highly unlikely because 8 Democrats would have to defect.

Budget reconciliation is a process in which the Senate can pass bills related solely to budgetary concerns with a simple majority vote. Through budget reconciliation, the AHCA will only need 51 Senate votes to pass. A 50-50 vote count would make it a tie. Vice President Mike Pence, a Republican, would then be called in to break the tie, thereby enabling the bill to pass.

Because of all this, the AHCA only handles things from a budget standpoint. It can’t change the law, but it can choose how to fund or not to fund various things pertaining to healthcare. It can, for example, repeal taxes and penalties (like the individual and employer mandates).

Phase 2: Administrative Actions

The second phase of Obamacare repeal requires much less arguing and vote counting than the first and third phases. That’s because this phase relies mainly on President Donald Trump and Secretary of Health and Human Services Tom Price.

This phase includes all the actions that the HHS Secretary can take without needing Congress’s approval. Price has a great degree of discretion because the Affordable Care Act has about 1,400 instances in which it clearly states that the HHS Secretary has the ability to do certain things related to healthcare regulation, pricing, and stabilization.

We’re not sure what Price is going to do specifically, but in a press conference on March 7, 2017, Price stated that he and his team were going to “go through every single one” of the provisions related to his office to determine what to keep, what to change, and what to not enforce. “If [the provisions] harm patients or increase costs, then obviously they need to be addressed,” said Price.

Phase 3: More Legislation

Phase 3 covers Republican proposals that aren’t covered in Phase 1 and cannot be put in place solely by the president or the Secretary of Health and Human Services.

This phase would consist of new legislation. This legislation would introduce new laws or directly repeal parts (or all) of Obamacare. These bills, which haven’t been revealed to the public yet, would require 60 votes in order to overcome a filibuster. It might be years before the bills in phase 3 could be passed and/or would take effect, according to Ryan.

Some of the things that might be covered in Phase 3 include “allowing individuals to purchase insurance coverage across state lines” and implementing association health plans.

Where Do We Go from Here?

The House is currently preparing the AHCA for a vote. From there, if it passes, the bill will go to the Senate. Many people are unsure about whether or not the bill will pass the House. There is also a great deal of skepticism over whether or not it will pass the Senate, too. Secretary Tom Price will be able to change regulations as he sees fit due to the powers of his office. If the AHCA were to pass both houses of Congress though, we would begin to see more bills coming from Congress to repeal and replace Obamacare.


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