Donald Trump Prepares Repeal and Replace For ACA (Audio)

that would burden states, individuals, or healthcare providers. It's not clear what this order is going to mean in practice, but on Sunday, Presidential advisor Kelly Anne Conway said that the President may decide not to enforce the Affordable Care Acts mandate that individuals purchase health insurance, and she also seemed to suggest that the administration may refuse to enforce the requirement that businesses with fifty or more employees provide

health insurance to their employees. Meanwhile, to Republican senators have introduced a bill that they say would let states keep Obamacare, abandon it, or replace it with a system of catastrophic insurance for the uninsured. So what does this all mean? Here today to talk with us about the future of

the Affordable Care acter ALDN. Bianchi, leader of the Employee Benefits and Executive Compensation practice Group at mince Levin, who is the author of the Bloomberg Bienna Healthcare Reform advisor, and Abbey G. Look, Faculty director of the Solomon Center for Health Law and Policy at Yale University. Abbey the Presidents signed an executive order that many are confused by UM and it's not really seemed to think, it's not really clear about what he what he wants agencies to

do with the Affordable Care Act. And then his advisor Ms. Conway goes on TV and says that he may not enforce these mandates. Let's start with that. Can the administration refused to enforce the two mandates to purchase insurance and to have employers provide insurance if they have fifty or more employees. Well, first of all, I think you're right that this action has sort of injected more uncertain change from already very uncertain business contacts for insurers because nobody

really knows what's going to happen. The executive order makes very clear that the agencies can only act to the extent authorized by law UM With respect to the individual mandate, the requirement that everybody has to get themselves insured or pay attacks a very very controversial requirement under the Affordable Care Act, UM. As a legal matter, it's very unlikely that the Trump administration could use that executive order the

wholesale abandoned the individual mandate. That would not be permitted consistent with the law as the executive order requires. They could extend some of the hardship exemptions that were offered by the Obama administration, but the exception can swallow the rule. So the Trump is serious about obeying the law, and that you think is not consistently um. I don't think that what Kelly and Conway said is likely to hold forth.

I also just know that Tom Price, the HHS nominee, and his confirmation hearing, also alluded to the idea that they were not going to use that executive order, uh, the wholesale stop enforcing the individual mandate. All. Then, what do you make of Tom Price's testimony where Trump's choice for Health Secretary repeatedly refused used during the confirmation hearing to promise that no Americans will be worse off under

Trump's executive order to ease provisions of the Affordable Care Act. Well, one thing I begin by noting is is that I think Tom Price was not at all bloodied during yesterday's confirmation hearing. So if Democrats thought that they were going to somehow derail that domination, I think the hopes of that are fading very quickly. Then the question is is how does the how does replace go forward? And I think Representative Price has been been very cryptic in any numbers.

We have no idea or very little idea from his from his his public statements and testimony, exactly what he's

going to do. But we do have a comprehensive bill that he had two comprehensive bills, one a pure repeal bill on the reconciliation and the other repeal and replace that Tom that Tom Price either offered authored or as a co author, so we has we have his policy prescriptions, so we know I think we know what he wants to do and and and those prescriptions are very similar to the prescriptions in in five other major Republican proposals, So I think he's uh, we we we pretty much

know where he's going to go. You're listening to Bloomberg Law with Michael Best, June Grosso, and Greg Store and we are talking about the Affordable Care Act. The President's actions and statements have not yet repealed the law, and neither has Congress. UH. He's talking about it today, He's been talking about it since he took office, But it's not entirely clear what is going to happen to what

is known as Obamacare. Talking to us about the future of the health care law are Alden Bianchi, a member at mince Levin UH, and Abby glucka professor at Yale Law School. Abbey the President's executive Order, as you noted earlier, only allows agencies to do to take actions that are within the current law. But what has to the extent we can figure it out, what has the President ordered agencies to do in regard to the Affordable Care Act? Well?

Nothing yet. I mean, that's that's what's caused all this uncertainty. There's been a lot of talk, and you also have Trump throughout making statements like every American who currently has health insurance is going to keep their health insurance or get health insurance. Um. And yet you've got these Republican plans voting around that don't all do that? Right? And we've had now eight years of Republicans trying to come up with the consensus agreement on what their replacement plan

would be. We shouldn't be surprised that two weeks into the new administration they don't have their plan yet. They haven't had one for eight years for getting sort of different plans every day. I don't think anybody knows what's going on except the one thing I think that I think the administration and the Senate have heard the business community's complaints about the idea of repealing without having a replacement, or at least a partial replacement up in the wings.

Early on, it looked like they were going to get repealed with nothing. Looking now like um, there are at least some people in there who are really trying to have something to say before they get to repeal, and that would may make repeal take a lot longer, frankly, um than Trump would have wanted. All Republican Senators Susan Collins and Bill Cassidy, unveiled in Obamacare replacement bill this week,

tell us about some of the proposals that are out there. Well, if you look at that, there are probably give or take five key Republican proposals, and they do share an awful lot of common features. So if we could tick down the major ones pretty quickly rather than an individual mandate, that would be something called a continuous coverage requirement. This has been around since with HIPPA, and it has worked very well in the group market, and it should work

fine so long as people are generally employed. I think the problem with it comes where people are in and out of employment on routinely and they're at that feature not work so well. There's also the issue of of tax subsidies for employees, and they're both the replacement proposals in Obamacare have tax subsidies for low income folks to help purchase coverage, but what they do is very different.

So in Obamacare, those subsidies are are applied to the metallic tears of coverage goal bronze, silver, goal platinum, which are very very prescribed arrangements, whereas under the Republican proposals, it's it's kind of the wild West. You can purchase coverage across state lines, and perhaps and and and the design of these policies would they'll be huge variations in

what they cover or don't cover. Importantly, and lastly, in regard to the individual mandate, there's a provision in most of these proposals that says, um, if you can't get coverage, then we're going to revert to the state high risk polls. I don't have time really here to go through all of them. But one other feature I'll mention that is, UM sounds like a good idea, but it has been

problematic in the past in terms of enforcement. And that's the idea of small groups banning together to form association health plans. Uh. These have been abused commercially for the last twenty years, so enforcement would be the big deal here. They would also cannibalize the state small group markets. So those are a flavor of some of the proposals that are common to all of the five five Republican proposals. ABBY.

There there is a relatively new proposal from Senators Cassidy and Collins that seems to depart from some of the previous Republican proposals and that it would allow states if they want to to keep Obamacare in place. What what is their proposal? Yeah, it's an interesting, uh sort of compromise proposal. UM. It won't make some people happy because it's not actually repealing Obamacare. But what it does is it gives the states three options. UM. You might call

it a federalist proposal. One that's about state choice. Option one is you get to keep obama Care the way you have it if your state is happy with how it's functioning. That would probably happen, say in New York, for example. Option two is that you get to just be done with Obamacare. You get to stop receiving funds and you're out of the system and the state funds for it self as if Obamacare never been enacted. And a third option is this idea of sort of state innovation,

state choice. The state would be able to get I think it's of the money they would otherwise be getting under the Affordable Care Act, and they get to use that to put it into a state designed healthcare system of their choice. Right, so it's almost like a waiver. You might think of it as a souped up waiver from Obamacare, which we already had this wavor provision and the original Affordable Care Act, and you might think of

this is sort of cheering off of that. It does get rid of the individual mandate because that is the least popular, uh, the least popular provision, and it would adopt this continuous coverage requirement that all them just talked about all the is this uncertainty about the Affordable Care Act having any effect on the insurance marketplace right now, it is too early to tell that for certain, but there has to be some uncertainty underneath the hood that

hasn't bubbled to the surface yet. It just would be inconceivable to me that the carriers, in particular, we've got to be scratching their head saying where's our revenue coming from? And the individuals that are covered, or saying is my

coverage even going to be there? Coincidentally, I just I had a call last night just from one of my my partners who has a young son who is going to age out of the hit aged and has would have some real pre existing condition concerns, And this question to me, is my kid going to be all right? So yeah, I mean there has to be, although I can't I can't point you to to particular evidence at

this point, Abby. One of the issues that seems to have slowed down the trained to repeal Obamacare was that any replacement plan probably would have to survive a Democratic filibuster in the Senate, meaning it would need sixty votes in order to go forward, and that's going to be

very difficult for the Republicans to pull off. It seems do any of the Republican plans that we've been talking about, this replacement plan that the two senators have come up with, do any of them have any chance of getting to

a point where Democrats might start supporting them. So I haven't seen democratic leadership commentary on Cassidy Collins, but I do think that just based on its one day of life existence so far, that's probably the one that has the greatest possible chance, particularly if it were strengthened and in certain areas. I mean, it preserves things that Democrats care about. It preserves a Medicaid expansion, which is very important. It doesn't aim to privatize Medicare like the Paul ryan

Ran plan would. I could see maybe having the individual mandate remain optional, um and that would probably help these concerns. I think there is concern among progressives that the continuous coverage requirement would be punitive against people UH with less steady employment employment, which tends to be people that are falling in the gap between Medicaid and the private insurance market, the less fortunate um And so I could see that being a starting point, UM. But we really have the

act to see UM. How the Democrats are going to react to it. And I also think that Strucumer has been very clear that he doesn't want to help Trump out of this problem. Right. Um, they've created this uncertainty, that sort of created this mess, and I think the Democrats wanted to say, you know, we're not going to take the blame by helping you enact a subpar replacement for the Affordable Care Act. So that's a challenge. All

then we have about thirty seconds left. Do you think the Republicans can come up with something that will they'll be able to replace Obamacare with anytime in the near future. I think they do, and I think if you want to know what that's going to look like, probably the most thoughtful proposal is the one that was put forward by Range Hatch. Now it's not a it's not legislation yet, say it's a five or six or seven page set of bullet points, but it is and I think it's

been been reviewed fairly favorably. Um, whether it will do what I doubt very seriously do what the Affordable Care Act did, but it's pretty good. And lastly, i'd point out that that people have seemed to have forgotten very quickly that the Affordable Care Act was really a Republican proposal. It was, it was done by a Republican governor, Mitt Romney, and it was designed by the Heritage in large part

by the Heritage Foundation. So it just shows you how far we've we've we've gone from our moorings on this on this topic, well, I suspect we also won't stop talking about it for some time to come. Thank you to Aldon Bianchi of mince Levin and Abbey Gluck of Yeah Law School for being with us today on Bloomberg Law