Blog Post

ACA Repeal and Replace: Where Do We Stand?

February 16, 2017

by Healthforce Center Senior Manager of Strategic Initiatives Rebecca Hargreaves

Information overload or not enough information? These days it feels like both. Each morning brings a fresh news cycle, every week another report and each meeting we attend presents new stories and opinions. We are inundated with headlines and data, yet are still trying to understand the implications of where the shifting details regarding the potential repeal or replacement of the ACA leave us.  

In an effort to cut through the noise, I wanted to share with you what I learned this week at a talk given at our most recent seminar for the 15th cohort of the CHCF Health Care Leadership Program by Kimberly MacPherson, a health policy expert and faculty member from UC Berkeley. In the span of just 2.5 hours, Kim helped our group of clinical leaders make sense of the different political forces at play and understand the current state of an ACA repeal and replacement plan.

A few key takeaways:

Now eyeing a 2018 timeline

President Donald Trump said in an interview last Sunday that a replacement health care law can be expected in 2018. This is a significant departure from earlier promises to roll out a replacement law in tandem with, or immediately after, the confirmation of a new secretary of Health and Human Services (HSS). Tom Price was confirmed as HHS secretary February 10, 2017. 

Significant changes to ACA, Medicare and Medicaid likely

Secretary Price is a seasoned physician and politician with deep legislative experience.  As the new HHS secretary, he has significant power to dismantle the ACA and make other sweeping changes. We do not know exactly how those changes will play out, but we have clues from his earlier efforts. Price is the author of one of the most detailed repeal and replace proposals to date – Empowering Patients First Act –, which supports a full repeal of Medicaid expansion and generally favors a diminished government role in health care.

Price has power to enact some immediate changes

Though many aspects of repeal and replace will take time, Secretary Price could enact some immediate changes through executive action. Key things to watch for in the coming weeks and months include: the possible removal of the mandate guaranteeing contraception coverage, lack of enforcement of the mandate requiring individuals to purchase insurance if they do not have it through other mechanisms and narrowing the list of benefits insurers are required to provide.  More details on what Price could accomplish through executive action can be found here.

Voices of concern

Changes are not happening in a vacuum and there are calls from both sides of the political aisle for accountability. California Governor Jerry Brown, a democrat, wrote an impassioned letter to House Majority Leader Kevin McCarthy (R-Calif.) cautioning that if the ACA was repealed without a strong replacement, consequences could include insurance market instability and high emergency room use.  Senator Lamar Alexander (R-Tenn.) is calling for “repairing” the ACA” in advance of repealing it. It has become increasingly clear that a swift dismantling of the ACA without a strong alternative plan already in place would wreak havoc on the health care system. Keep an eye out for more politicians voicing their concerns no matter which side of the aisle they come from.

What have you learned this week?  How is it helping you plan for the future while maintaining focus on today?  We’d love to hear from you.  Email us at [email protected]

Looking for more information?  Here are a few of our favorite sources:

Kaiser Health News Repeal and Replace Watch

Vox Health Care

The New York Times health beat reporter Robert Pear

Rebecca Hargreaves is the senior manager for strategic initiatives at Healthforce Center at UCSF.  She leads the development of new programs and projects that advance Healthforce Center’s mission to equip health care organizations with the workforce knowledge and leadership skills to effect positive change in health care.  Rebecca has a masters degree in public policy from Harvard University’s Kennedy School and a BA in economics from UC Berkeley.