Congress returns with Trump pressing anew for ACA repeal/replace, but with what?

Donald_Trump-1-225x300Welcome back, Republicans in Congress. When you went home for spring break, constituents made raucous complaints, if you held town halls, about the GOP’s failure to repeal and replace the Affordable Care Act, aka Obamacare. The party’s substitute, the American Health Care Act, aka Trumpcare, grows  more unpopular by the day, opposed 56 percent to 17 percent in one recent national poll. GOP candidates, in special elections in staunchly Republican districts, including one just vacated by the new Health and Human Services secretary, have barely survived.

And now President Trump, with House GOP conservatives and moderates negotiating furiously, insists  there will be a swift replay vote on ACA repeal and Trumpcare replacement.

Sometime soon.

The president first trumpeted the action would occur this week, ahead of the administration’s April 29 100-day mark —and even as Congress grapples with the complexities of the nation’s budget and the lifting of the debt ceiling to ensure the government does not shut down.

Then he said never mind, Trumpcare is getting “better and better and better, and it’s gotten really, really good, and a lot of people are liking it a lot,” so the president changed his mind and said it would win approval in weeks.

Except the GOP’s latest version of Trumpcare didn’t exist as of Friday as a written bill that could be read and studied, especially by experts who can tell lawmakers and the public what it will or won’t do in providing Americans health care coverage—and at what cost.

Instead, House Republicans, lobbyists, journalists, and health policy experts mostly were poring over a one-page document, reported by Politico as a Trumpcare compromise. It describes an agreement apparently struck between conservative House Freedom Caucus chair Rep. Mark Meadows and so-called “moderate” Tuesday Group chair Rep. Tom MacArthur. Some GOP representatives in the House said this language bridges the political chasm between those who want no government role, or a sharply lessened one, in health care, and those who don’t want tens of millions of Americans stripped of Obamacare coverage.

The analyses of the latest Trumpcare still don’t look good for the GOP:

Without a bill to examine, it’s also impossible to see if GOP lawmakers have softened Trumpcare’s slashes in Medicaid, the federal program that offers key health coverage to the poor, young, old, disabled, and chronically ill and many in the middle class. Obamacare significantly expanded Medicaid, and GOP leaders, including so-called “moderates” were loath to see tens of millions of Americans losing  coverage or benefits due to Trumpcare. It’s unclear for now what the GOP plans to do with myriad other Obamacare efforts to improve the quality, safety, access, and costs of medical services in this country.

And though Obamacare stands as the law of the land, a “zombie” Trumpcare or ACA replacement in limbo couldn’t lurk at a worse time for insurers. They’re deciding on deadline whether to participate in ACA exchanges and what their rates might be, with Trump and others in the administration offering conflicting views on critical federal subsidies for Obamacare. Trump officials also aren’t detailing how they might assist Americans in areas where few or no insurers offer ACA coverage. The administration’s actions seem in keeping with the president’s pledge to “blow up Obamacare” or to let it wither and fail, though analysts continue to underscore that the ACA coverages are working fine, actually and they’re heading to insurer profitability—not a “death spiral.

In my practice, I see not only the huge harms that patients suffer while seeking medical services but also the huge financial strains that result from costly medical care. Health insurance is not the only critical component of Americans’ health. But without coverage, too many of us skip vital care—or we receive it a greater expense when our health dives into catastrophic circumstance. Obamacare is imperfect. But it at least starts to address life changing and saving issues of health coverage and it has affected runaway medical costs. Medical debt remains a major driver of bankruptcy in this country, even as more Americans than ever have gotten health insurance thanks to the ACA. It’s upsetting that doctors and hospitals keep turning to rapacious debt collectors, and that research finds that two-thirds of those complaining about these vultures actually don’t owe anyone anything for supposedly uncollected medical services’ costs. I know health policy issues are complex and daunting to most of us. But with our health at stake, we must monitor and guard against harms partisans may wreak on an important economic sector that comprises 17.5 percent of the nation’s GDP and in which we spend more than $3 trillion annually.

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