Repeal and Replace

GOP Plan Aims To Curb Medicaid, Expand State Options

Mar 23, 2017

For all its populist design, the House Republicans’ latest proposal to overhaul federal Medicaid funding creates financial risks for states and could leave some enrollees worse off.

Dramatic changes in Medicaid are a big part of the House bill to partially repeal the Affordable Care Act that’s steaming toward a floor vote scheduled for Thursday.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

KELLY MCEVERS, HOST:

The Affordable Care Act's tax penalty for people who opt out of health insurance is one of the most loathed parts of the law, so it is no surprise that Republicans are keen to abolish it. But the penalty, also called the individual mandate, plays a vital function: nudging healthy people into the insurance markets, where their premiums help pay for the cost of care for the sick. Republican lawmakers think they have a better alternative.

Darvin Bentlage says his health insurance plan used to be the same as all the other cattle farmers in Barton County, Mo.: Stay healthy until he turned 65, then get on Medicare. But when he turned 50, things did not go according to plan.

"Well, I had a couple of issues," he says.

He's putting it mildly.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

LAKSHMI SINGH, HOST:

The Republican bill to repeal and replace the Affordable Care Act would make significant changes to the U.S. health insurance system. It would unwind many of the taxes and coverage mandates of the law, also known as Obamacare. And it would gradually overhaul Medicaid.

The bill would affect incomes and health coverage for millions of Americans. Some people would be better off. Others would be worse off. The original bill could change as it makes its way through Congress, but here's an early forecast of some of the winners and losers.

"This is the chance. This is a once-in-a-lifetime opportunity," said the speaker, roving the stage with a wireless mic, gesturing at both the audience in front of him and the PowerPoint presentation behind him.

TED Talk? Late-night infomercial? Nope — it was House Speaker Paul Ryan, making a hard pitch for his health care plan after a week of loud conservative criticism.

The Republican health care overhaul working its way through the House is opposed by Democrats and by many Republican conservatives. It's none too popular with the people on the front lines of health care, either — including doctors, nurses and hospitals.

The chief medical officer of Medicaid, Dr. Andrey Ostrovsky, tweeted out his opposition on Wednesday. "Despite political messaging from others at HHS, I align with the experts ... in opposition to #AHCA," the career staffer said.

Kaiser Family Foundation

People in their 50s and 60s could be hit with higher health insurance premiums and less financial help paying for them under a proposed replacement for the Affordable Care Act.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

ARI SHAPIRO, HOST:

We're going to start this hour by talking about the Republican proposal to replace the Affordable Care Act, or Obamacare. In a moment, we'll hear from a group that has come out against the plan, the AARP.

ROBERT SIEGEL, HOST:

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

ROBERT SIEGEL, HOST:

Over the strong objections of key conservatives and Democrats, House Republican leaders are forging ahead with a health care plan that scraps major parts of the Obama-era overhaul.

House Speaker Paul Ryan from Wisconsin has been complaining about the Affordable Care Act (aka Obamacare) for so long that his list of grievances sounds like a refrain of some pop song.

"Obamacare is collapsing," he said on Feb. 28. "The Democrats got too far ahead on their ideology and they gave us a system where government runs health care. They gave us a system where costs went up, not down. They gave us a system where choices went away. They gave us a system where people lost the plans they liked, they chose."

It took a lot to get to this point, but Republicans have released their long-awaited health care bill. (For more on the policy, check out the NPR health team's reporting over at Shots.)

The version that was released is likely to change as the bill goes through committees, but now that it's released, here are four potential challenges President Trump and Republicans face:

1. Health care is complicated

House Republicans unveiled their long-awaited replacement plan for the Affordable Care Act Monday night. They're calling it the American Health Care Act.

GOP Health Bill Jettisons Insurance Mandate, Much Of Medicaid Expansion

Mar 7, 2017
(Bill Clark/CQ Roll Call via Getty Images)

House Republicans unveiled their much anticipated health law replacement plan Monday, slashing the law’s Medicaid expansion and scrapping the requirement that individuals purchase coverage or pay a fine. 

After years of waiting, it's finally here.

President Trump's declaration during his speech to Congress Tuesday night that Obamacare is "collapsing" and must be replaced was cheered by Republicans.

But Republican lawmakers remain unable to coalesce behind an approach to their oft-stated goal of repeal and replace, and Democrats believe they hold the upper hand to the fate of the Affordable Care Act.

In an interview with Morning Edition host Steve Inskeep that aired Thursday, Senate Minority Leader Chuck Schumer said the odds "are much greater than half" that the ACA will remain in place.

Next year is almost here for American insurance companies wanting to sell plans on Healthcare.gov in 2018, assuming it survives the Obamacare repeal-and-replace effort.

President Donald Trump and Republican governors met Monday and the top topic was the Affordable Care Act. The president and congressional Republican leaders have pledged to repeal and replace the federal health insurance law known as Obamacare.

Many Republican leaders have promoted the idea that consumers should have a "health care backpack," which would make it possible to take insurance from job to job or when moving, starting a business or retiring.

Republicans are looking to President Trump to use his address to Congress Tuesday evening to define the party's path forward on how to deliver on the long-promised pledge to repeal and replace Obamacare.

The White House has, so far, ceded the decision-making to congressional leaders who are trying to unify competing moderate and conservative lawmaker demands behind a plan that can pass with narrow majorities in both chambers.

In recent days, several Republican lawmakers have faced crowds of constituents at town hall meetings around the country who are angry that they may be in danger of losing their health coverage.

No matter where you stand on the political spectrum, health care under the Affordable Care Act is going to change in the next few years. The Republican-led Congress has vowed to "repeal and replace" the health law known as Obamacare.

That has left many people anxious and confused about what will happen and when. So NPR's Morning Edition asked listeners to post questions on Twitter and Facebook, and we will be answering some of them here and on the radio in the weeks ahead.

There's a moment in the Broadway musical Hamilton where George Washington says to an exasperated Alexander Hamilton: "Winning is easy, young man. Governing's harder."

When it comes to health care, it seems that President Trump is learning that same lesson. Trump and Republicans in Congress are struggling with how to keep their double-edged campaign promise — to repeal Obamacare without leaving millions of people without health insurance.

Much has been written about the 20 million people who gained health insurance under the Affordable Care Act, and what could happen to these patients if the ACA is repealed without a replacement. But some people don't realize that hospitals nationwide could take a big financial hit on several fronts, too.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

ROBERT SIEGEL, HOST:

The repeal of the Affordable Care Act appears almost certain. On Monday (1/23) a Tallahassee doctor who also teaches at the Florida State University College of Medicine was speaking on what might happen next.

As promised, President Trump has moved to dismantle the Affordable Care Act. It's a concern for those who might be left without health insurance — and especially for the Department of Veterans Affairs, which may have to pick up some of the slack.

Carrie Farmer, a health policy researcher at the Rand Corp., says 3 million vets who are enrolled in the VA usually get their health care elsewhere — from their employer, or maybe from Obamacare exchanges. If those options go away, she has no idea just how many of those 3 million veterans will move over to the VA.

Donald Trump and Republicans in Congress are vowing to repeal and replace the Affordable Care Act, the signature health care overhaul of President Obama.

Trump has offered a few ideas of where he'd like to see a health care overhaul go, such as a greater reliance on health savings accounts, but he hasn't provided a detailed proposal.

Pages