Top things to know about the ACA

Posted by Reeve Staff in Daily Dose on February 22, 2017 # Advocacy and Policy

The fate of the Affordable Care Act has been in the news almost constantly since the 115th Congress convened earlier this year, with hundreds of news stories discussing the repeal, replacement, or repair of ACA. Because of the nonstop coverage, it can be difficult to discern what changes to ACA Congress and the Administration have actually proposed or implemented. So let’s break it down:

Has Congress actually started work on repeal or a replacement?

Yes, with a “but.” In January, the Senate passed legislation that allows them to make changes to the ACA without the threat of a filibuster. Since then, however, other than introducing several different proposals and devoting many hours to floor speeches, no other legislative work has been done. In legislative terms, we’re no closer to repeal or a replacement than we were on the day Trump took office.

Why is the process so slow?

Despite what some officials have promised (and continue to promise), there was never a realistic chance at a quick repeal, or swift significant changes to ACA – it’s simply too big. Republican staff on they key committees with jurisdiction over the law - who knew what an arduous process this would be - acknowledged as much. Remember, the bill took months to write and pass, and years to implement; there was never a chance taking it apart could happen quickly.

Have the Republicans put forth a replacement plan?

Several plans, actually. House Republican leadership released a memo on February 15 outlining their plan, which calls for a refundable tax credit based on a person’s age to help people afford coverage. But the plan is still in its early stages and it’s unclear how much it would cost. In addition, the more conservative wing of the party has taken issue with using tax credits as a subsidy, and floated their own plan which would de-couple health insurance from employers, offer a tax credit of up to $5000 to fund Health Savings Accounts, and eliminate most regulations on what health plans must cover. Neither plan (as of yet) seeks to eliminate key facets of ACA such as refusing to insure someone with a pre-existing condition, or allowing young people to stay on their parent’s plan until they’re 26.

How would their plans affect Medicaid?

Republican leadership and the more conservative Freedom Caucus disagree on this as well; House Speaker Paul Ryan (R-WI) has said that any replacement should accommodate states that expanded Medicaid under ACA. After a transition period (the length of which is unclear), states could choose to keep Medicaid open to newly eligible people, but would no longer receive federal funding to cover the cost. The Freedom Caucus plan, however, would end ACA’s Medicaid expansion outright. This has put several Republican governors whose states have entered Medicaid expansion in the awkward position of defending a law they had previously decried. Finally, Seema Verma, Trump’s pick to be the Administrator of the Centers for Medicare/Medicaid, refused to endorse any particular reform plan during her confirmation hearing.

What’s Next?

Despite the divisions in the ranks, Republicans will likely begin work on the leadership the week of February 28; this will be the first point we’ll see actual legislative language that has a chance of becoming law. Should any provisions of the bill appear to be detrimental to the mobility impaired community, we will launch a campaign to fight back and tell legislators to do what’s right.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.