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Debate, fluidity continues over repeal, replacement of ACA

The United States Senate is more than halfway through 20 hours of debate over the so-called “skinny repeal” bill that would start the process of eliminating the Affordable Care Act.

Though the bill is very fluid and mostly unknown at the time of this writing, certain components have risen for discussion.

“We have heard that it could include repeal of the individual and employer mandates, 1- year defunding of Planned Parenthood, additional money for the Community Health Center fund, and potentially additional flexibility for section 1332 waivers for states,” Pari Mody, associate of Arnold & Porter Kaye Scholer LLP, told Healio Family Medicine in an interview.

“Notably, leadership has reportedly dropped [Affordable Care Act] tax repeals, including repeal of the medical device tax, from the skinny repeal bill, after a Congressional Budget Office estimate commissioned by Democrats found that the skinny repeal bill did not achieve sufficient savings.”

She also stated that the bill would need to achieve $133 billion in deficit reduction, but the Congressional Budget Office estimate found that the skinny repeal would fall $3 billion short of that goal.

Sen. Bern ie Sanders, (D-Vermont) cited ongoing concerns groups such as AAFP, AMA and ACP have voiced on the bill, as well as the lack of transparency among Republicans.

“One might think that when virtually every major national health care organization in this country are opposed to this legislation, my republican colleagues might think twice about going forward,” he said in remarks made on the Senate floor. “They have not had in this opportunity – amazingly enough – to hear from doctors ... because that, despite the fact that we are dealing with an issue that impacts every single American, ... there has not been one public hearing on this bill. This bill has been written behind closed doors.”
Democrats said their party will not propose any additional amendments until they see the skinny repeal bill.

A Republican lamented that the debate is not focused where it should be.

“Stop pretending [the ACA] is affordable. Our system is not affordable. It’s not portable and, fundamentally, it’s not really insurance,” Sen. Ben Sasse (R-Nebraska) said. “We should have a debate about portable insurance, about affordable insurance vs. socialized medicine. ... This is a lost opportunity for the American people. We can and should do better.”

Approximately 7 hours of debate remain as of this writing. Mody anticipates that the vote on the skinny repeal bill will occur on Friday. - by Janel Miller

Disclosure: Mody works for Arnold & Porter Kaye LLP. Healio Family Medicine was unable to determine relevant financial disclosures prior to publication.