Sarah Kliff · Monday, June 12, 2017, 8:19 am
The Affordable Care Act is in deep trouble — in Washington and large swaths of the country.
Senate Republicans began to coalesce around the framework of a plan to repeal and replace the law last week. Their plan would, like the bill the House passed in May, almost certainly cause millions of low-income Americans to lose coverage by ending the Medicaid expansion. It would help the young and healthy at the expense of the older and the sick.
Meanwhile, across the nation, health insurance plans are beginning to flee the Obamacare marketplace. They’ve cited the uncertainty around the health care law’s future, sown by congressional Republicans and the Trump administration. The number of counties with zero health plans signed up to sell 2018 coverage keeps growing.
The possibility that Republicans will repeal Obamacare or drive it into collapse is an increasingly real one. That’s a reality where millions fewer have health insurance coverage and lower-income Americans struggle to afford coverage.
“Slowly but surely, I think we’re gonna get there,” Sen. John Cornyn (R-TX), the No. 2 Republican, told reporters on Thursday, regarding Obamacare repeal. “We’re coming together.”
The Senate repeal plan is coming together — and looks a lot like the House repeal plan
Behind closed doors, Senate Republicans have worked out a path toward Obamacare repeal. The plans under discussion would end Medicaid expansion, causing millions of low-income Americans to lose health coverage. They may allow health insurance plans to charge higher premiums to people with preexisting conditions, too.
In other words: The emerging bill looks a whole lot like the unpopular bill the House passed last month. It creates the same group of winners (high-income, healthier people) and the same group of losers (low-income, sicker people).
The Republican plan is coming together because moderate senators are beginning to drop some of their initial repeal objections. Sens. Rob Portman (R-OH) and Shelley Moore Capito (R-WV), for example, now back a plan to end the Medicaid expansion.
Both were ardent critics of the House bill’s deep Medicaid cuts, which would cause 14 million Americans who rely on the public program to lose coverage. Portman put out a harsh statement the day the House passed its health care bill.
“I’ve already made clear that I don’t support the House bill as currently constructed because I continue to have concerns that this bill does not do enough to protect Ohio's Medicaid expansion population,” Portman said plainly.
But now Portman has endorsed a plan to phase out the Medicaid expansion entirely, just to do so on a longer timeline than the House bill. Portman and Moore Capito want a seven-year phase out, rather than the House bill’s three-year off-ramp.
At the end of the day, though, phasing out Medicaid expansion over seven years has the same effect as three years: You end coverage for millions of low-income Americans.
There are still major issues that divide Senate Republicans on repeal. There is disagreement, for example, over how much to cut the Medicaid program and what kind of subsidies to give people in the private market. But the fact that Republicans are coalescing around ending Medicaid expansion — once thought to be a major sticking point — suggests the path to repeal may be easier to find than initial expectations.
Health insurance plans are fleeing the Obamacare marketplaces
Insurance plans are scaling back their Obamacare participation or quitting the marketplace entirely. Most cite the growing uncertainty over the law’s future — whether it will be repealed and how the Trump administration will implement it.
In the past week, the number of counties with zero health plans signed up to sell Obamacare has doubled. There are now 38,000 Obamacare enrollees scattered across 47 counties where no insurers want to participate in the marketplaces.