By John Falardeau
A featured campaign promise of newly inaugurated president Donald J. Trump was the extermination of the 2010 Affordable Care Act, better known as “Obamacare.” During 2015 and 2016, candidate Trump did not mince words when speaking out against Obamacare. It can certainly be argued that Trump’s stance on the Act was a major factor in his win in November. Trump claimed the Act was simply not working and that, in turn, millions of Americans were paying for substandard care and that the premiums of those who were not accessing Obamacare plans were skyrocketing.
The 20th Amendment to the Constitution states that the new president is sworn in on Jan. 20 at noon eastern time in the year immediately following the national election. President Trump wasted little time that afternoon as one of his first executive orders was to grant the heads of all federal agencies the ability to halt implementation of any provision in the law that would fiscally burden states, hospitals, insurers, patients or drug and device manufacturers. Presidential scholars and many government officials believe that the order is largely symbolic in nature, since it does not grant agency leaders any powers that are not already allowed under current statute. But it achieves President Trump’s goal to take immediate action on the law and is an indication to Congress that the president wants to see immediate action on legislation.
Nevertheless, some Republicans in Washington were caught off guard by the order, since many believed there would not be any action surrounding Obamacare until President Trump’s nominee to head the Department of Health and Human Services, Rep. Tom Price (R-Ga.), is confirmed by the Senate. At this time, the Senate is still deliberating Price’s nomination as questions have arose regarding certain health company stock purchases.
Another bombshell was thrown on Jan. 22--less than 48 hours since the inauguration--by presidential advisor Kellyanne Conway, when she announced that the Trump administration may not even enforce the law’s mandate that individuals must have insurance or pay a fine. In turn, this announcement was disconcerting to insurers since they rely on the mandate to keep coverage affordable.
In another surprising move just days after the inauguration, Republican senators Bill Cassidy of Louisiana and Susan Collins of Maine rolled out a proposal that would let states choose whether to keep their existing health insurance marketplaces or scrap them and adopt a new, more conservative plan. The first replacement plan to be proposed in the Senate, the Cassidy-Collins bill, would allow state legislatures to choose whether to continue the insurance market put in place under Obamacare or opt into a new system that would offer less comprehensive plans that would be less expensive. Other moderate Senate Republicans, most notably West Virginia’s Shelley Moore Capito and Georgia’s Johnny Isakson, have indicated they also like this approach of “replacing” Obamacare. Senate conservatives, on the other hand, may see this approach as one that doesn’t go far enough and could run into rough sledding in the Senate Republican conference.
The most likely option, I still believe, to supplant the Affordable Care Act remains the budget reconciliation process, one that was used in 2015 but was vetoed by then-president Obama. Under this congressional procedure, only 51 votes are needed to pass the bill in the Senate, but each provision must have a significant budgetary impact, which would limit the scope of the repeal initiative. However, Republicans know they cannot get the necessary 60 votes in the Senate to move anything larger because of their slim 52-48 majority in that chamber.
Even with the week’s executive orders and the Cassidy-Collins announcement, questions about the future of Obamacare loom large. Will Sec. 2706, the provider non-discrimination provision found in the law, survive the attempts to dismantle Obamacare? Will Congress simply expand Medicaid, Obamacare’s favorite insurance plan? Will the idea of selling insurance across state lines be brought up again? These are all questions that affect chiropractic and remain on the front burner of the American Chiropractic Association (ACA).
As an ACA member, you can be assured that ACA is on Capitol Hill every day fighting for your interests and the interests of your patients. No other chiropractic organization has the influence, clout or connections in Washington needed to advance the profession. However, we are only as strong as our membership, so if you know a colleague who is not a member, please point them to www.acatoday.org/join, and urge them to show their support of your profession by becoming an ACA member.
John Falardeau is senior vice president of public policy and advocacy at the American Chiropractic Association.