On the floor of the Senate Tuesday afternoon, a senate committee chairman with jurisdiction over Obamacare offered the most detailed plan since the election to repeal and replace the ACA.
Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-TN), who has long advocated for a “simultaneous” approach to scrapping and replacing the Affordable Care Act, said that Republicans should be focused on repairing Obamacare’s exchanges while building a new system to deliver health care to the American people.
It’s still unclear whether Alexander’s plan has the blessing of leadership, nor is it clear whether the GOP will follow through with it ultimately, but Alexander’s speech gives real insight into how a powerful and respected Republican chairman is trying to get his party to think about repealing and replacing Obamacare and what he thinks Republicans should be doing to build their own system.
Here’s what you should know.
No Repealing Obamacare Till a New System is Built
This agrees with what Trump said during his press conference. However, Alexander seems interested in taking his time to develop a plan that works. He only wants to see Obamacare repealed once “there are concrete, practicable reforms in place.” “It’s not about developing a quick fix. It’s about working toward a long-term recovery that works for everyone,” Alexander said.
Save Obamacare in a Rescue Mission
Alexander said that he wants to first “rescue” the current Obamacare exchanges because people are still on them. “First we’ll offer a rescue planning so that the 11 million Americans who buy insurance now on the exchanges can continue to do so while we build a better set of concrete, practical alternatives.” To do that, Alexander wants “Congress and the president to take action before March 1, which is when insurance companies begin to decide whether they will offer insurance on these markets during 2018. Instead of plans that comply strictly to the Obama mandates, i.e. pre-existing conditions allowed, allowing adult children to stay on the parents insurance …, states would be allowed to approve their own plans during the transition period.
Make Sure the Insurance Market is Stable
During the transition, Alexander said Republicans should continue the cost-sharing subsidies that insurers get for covering low-income people on the exchanges. He also advocated “repeal [ing] the individual mandate when new insurance market rules are in place” and giving individuals the opportunity to use their Obamacare subsidies to purchase health insurance outside of the Obamacare exchange.
Build a New Health Care System, Step-By-Step
Alexander also said Republicans would then go to work on building a new health care system. “I say systems, not one system. If anyone is expecting Senator McConnell to roll a wheelbarrow on to the Senate floor with a Republican health care plan they’re going to be waiting a long time because we don’t believe in that. We don’t want to replace a failed Obamacare federal system with a failed — with another failed federal system. We want to create many systems across this country step by step … we’ll do this by moving more health care decisions out of Washington and into the hands of states and patients.”
Preserve Coverage for People With Pre-Existing Conditions
Alexander also promised that replacing Obamacare would not make changes to Medicare nor would the bill be used to take away protection for people who have pre-existing conditions. The replacement would also allow people to stay on their parent’s plans until they’re age 26, Alexander said.
Give States More Wiggle Room On Medicaid
Alexander wants states to be able to expand Medicaid, but he doesn’t want them to have to bend over backwards to get waivers from the Trump administration.
“We will give states more flexibility to offer those 62 million citizens more options by making federal Medicaid waivers more flexible,” Alexander said.
Expand Health Savings Accounts
In order to build a new system, Alexander advocated Wednesday to expand health savings accounts and “eventually provide tax credits to help lower-income Americans buy insurance.”
Get rid of the Employer Mandate
To guarantee that employers get a break from Obamacare, Alexander wants Republicans to repeal “Obamacare’s employer mandate penalty.”
“We will allow states to determine the so-called essential health benefits and thereby lower costs for small businesses,” Alexander said. “We’ll repeal Obamacare’s restrictions on grandfathered health plans, on wellness benefits, on small group plans and provide more flexibility for small businesses.”