Repeal and Replace Obamacare Simultaneously, Concurrently

Posted on January 11, 2017

Following the presidential election, President-elect Trump said on “60 minutes” that replacement and repeal of Obamacare would be done “simultaneously.” To me, that means at the same time.

And then just Tuesday Speaker of the House Paul Ryan said that repeal and replacement of Obamacare would be done “concurrently.”

To me, “simultaneously” and “concurrently” means Obamacare should be finally repealed only when there are concrete, practical reforms in place that give Americans access to truly affordable health care.

The American people deserve health care reform that’s done in the right way, for the right reasons, in the right amount of time. It’s not about developing a quick fix. It’s about working toward long-term solutions that work for everyone.

One way to think about what “simultaneously” and “concurrently” mean is to think about Obamacare in the same way you would think about a collapsing bridge in your hometown, because that is just what is happening with Obamacare.

According to the Tennessee insurance commissioner, the Obamacare insurance market in our state is “very near collapse.” Across the country, premiums and co-pays are up and employers have cut jobs to afford Obamacare costs. Medicaid mandates are consuming state budgets. In one third of America’s counties citizens with federal subsidies only have a single choice of company to buy insurance from on Obamacare exchanges. Without quick action, next year they may have zero choices. Their subsidies may be worth as much as a bus ticket in a town where no buses run.

If your local bridge in Wyoming or Tennessee were “very near collapse,” the first thing you would do is send in a rescue crew to repair it temporarily so no one else is hurt.

Then you would build a better bridge, or more accurately, many bridges, as states develop their own plans for providing access to truly affordable health care to replace the old bridge. Finally, when the new bridges are finished you would close the old bridge.

That is how we propose to proceed: to rescue those trapped in a failing system, to replace that system with a functional market, or markets, and then repeal Obamacare for good.

First, we will offer a rescue plan so the 11 million Americans who buy individual insurance now on the exchanges can continue to do so while we build a better set of concrete, practical alternatives.

Second, we will build better systems providing Americans with more choices of insurance that costs less. Note I say systems, not one system. If anyone is expecting Senator McConnell to roll a wheelbarrow on to the senate floor with a comprehensive 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 another failed federal system.

So, we will build better systems providing Americans with more choices of insurance that costs less. We will do this by moving more health care decisions out of Washington and into the hands of states and patients and by reducing harmful taxes. And we will do this carefully, step by step, so that it is effective.

Finally, we will repeal what remains of the law that did all this damage and created all this risk.

That is what we WILL do.

Here is what we WILL NOT do.

This is not the bill for Medicare reform. That will be handled separately.

Secondly, you will not be disqualified from getting insurance if you have a pre-existing health condition and if you are under the age of 26, you will still be able to be covered on your parent’s plan.

That is what we mean by repeal and replace, simultaneously and concurrently.

Here are three steps we will take, beginning immediately:

1. The rescue plan—6% of Americans with insurance buy their health insurance in the individual market, including the Obamacare exchanges. This is where much of today’s turmoil is: higher premiums, higher co pays and insurers pulling out of markets. While we build a replacement, we want the 11 million Americans who now buy on the exchanges to be able to continue to buy private insurance. This will require Congress and the President to take action before March 1, which is when insurance companies begin to decide whether they will offer insurance in these markets during 2018.

In general, the goal is to get as close as possible to allowing any state-approved plan to count as health insurance under Obamacare rules, while we are transitioning to new systems. Among actions that will help are to allow individuals to use their existing Obamacare subsidies to purchase state-approve insurance outside Obamacare exchanges; adjust Obamacare’s special enrollment periods; approve the temporary continuation of cost sharing subsidies for deductibles and copays; allow states more flexibility to determine so-called “essential health benefits,” age-rating rules and small group restrictions; expand health savings accounts; eventually provide tax credits to help lower income Americans buy insurance; and repeal the individual mandate when new insurance market rules are in place. When the new administration rewrites the guidance on Obamacare section 1332 state innovations waivers to allow for more state flexibility, states will have the authority to further innovate to build more modern health systems.

2. On employer insurance—61% of all Americans who have insurance coverage get it on the job. We will repair the damage Obamacare has done so employers can offer employees more personalized, patient-centered care. We will repeal Obamacare’s employer mandate penalty; allow states to determine the so-called “essential health benefits” and thereby lower costs for small businesses; repeal Obamacare’s restrictions on grandfathered health plans, wellness benefits, small group plans, and provide more flexibility for small businesses so they can work together to buy insurance. This will mean more state authority, more choices and lower costs for the 178 million Americans who obtain insurance on the job.

3. Medicaid—22% of all insured Americans are covered by Medicaid. We will give states more flexibility to offer these 62 million citizens more options by making federal Medicaid waivers more flexible.

In summary, we will first send in a rescue crew to repair temporarily a collapsing health care market so no one else is hurt.

Then, step by step, we will build better systems that give Americans access to truly affordable health care. We will do this by moving health care decisions out of Washington, D.C., and back to states and patients.

Finally, when our reforms become concrete, practical alternatives, we will repeal the remaining parts of Obamacare in order to repair the damage it has caused Americans.

This is what I believe we mean when we say Obamacare should be repealed and replaced, simultaneously and concurrently.