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The election of Donald Trump signaled strongly that the Affordable Care Act was in for an even bumpier ride than it had already been on.

As a candidate, Trump had railed against Obamacare — as former President Barack Obama’s massive health care overhaul is often known. He promised to do what a Republican-controlled Congress had been vainly attempting to do for years: repeal and replace the bill.

First came the American Health Care Act, a House measure released in March. Blasted from both the right and the left, the bill was eventually pulled from a vote by Speaker Paul Ryan, who told the president that he lacked the support to get it passed. Among other things, the bill would have eliminated the individual mandate, charged more for those who purchased insurance outside of the open enrollment period, and pegged tax subsidies to age rather than income.

Although Trump suggested the vote was the only chance for lawmakers to repeal Obamacare, a new AHCA was unveiled by the House in May. It kept several pieces of the original bill, but it changed others. For instance, it would have allowed insurance companies to charge people with pre-existing conditions more. It passed narrowly, 217-213, with every Democrat and 20 Republicans voting no. Health care officials in Wyoming were alarmed by the bill, warning that it would causes prices to jump and would adversely affect old and sicker Americans.

The ball, then, was in the Senate’s chamber. A small group of Senate lawmakers began crafting its version of the ACA replacement bill in secret, finally revealing what became known as the Better Care Reconciliation Act. Like the House’s bill, the BCRA would eliminate the individual mandate. It would also roll back ACA taxes and change how Medicaid dollars are distributed to the states. It would also allow states to opt out of offering essential health benefits — like maternity care and prescription drugs.

That measure — written and praised by Wyoming’s senators — also drew condemnation from the state’s health care officials.

But that, too, failed. So, did a number of subsequent efforts that were introduced in the Senate between July and September. Because Republicans held a slim majority in the chamber, they could afford only a handful of defections. And in the face of uniform Democratic opposition, the decisive no votes came from the right.

By October, the Congress was preparing to move onto tax reform legislation. Repeal efforts had failed repeatedly. Costs had jumped amid the uncertainty emanating from Washington, but the ACA had largely survived the first 10 months of 2017.

But while Republican leaders had failed to deliver a knockout blow, they began peppering Obamacare with jabs. One of the more sizable hits came in October, when the president made two moves: One eased insurance rules and the other cut off payments to insurance companies, intended to offset costs incurred by the insurers for giving subsidized plans to lower-income Americans.

(Intended or not, the latter change actually helped a number of Americans purchased cheaper insurance.)

Next, and more crucially, came the tax bills. Congress passed, and Trump signed, a tax bill that included a provision to repeal the individual mandate. The Congressional Budget Office has said this will result in 13 million fewer people having health insurance.

Any other future moves made against the Affordable Care Act remain up in the air.

Follow education reporter Seth Klamann on Twitter @SethKlamann

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Education and Health Reporter

Seth Klamann joined the Star-Tribune in 2016 and covers education and health. A 2015 graduate of the University of Missouri and proud Kansas City native, Seth worked for newspapers in Milwaukee and Omaha before coming to Casper.

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