Efforts at Healthcare Reform Range From Repeal, Replace to Single Payer

On Wednesday, Republican senators introduced HR 1628, a new effort to repeal and replace the Affordable Care Act (ACA).

The bill, sponsored by Republican senators Bill Cassidy (Louisiana), Lindsey Graham (South Carolina), Dean Heller (Nevada), and Ron Johnson (Wisconsin), and written with additional input from former Pennsylvania Republican senator Rick Santorum, proposes to repeal the ACA, including the individual health insurance mandate, and replace it with state block grants given annually to help individuals pay for healthcare. According to a press release issued by the office of Senator Cassidy, the block grant would be subject to a mandatory appropriation.

“This past week, we heard testimony from Democrat and Republican governors and Medicaid directors who believe that, with increased flexibility and freedom from Washington, DC regulations, they can do a better job of providing coverage for the people of their state. We agree,” said Cassidy. “This amendment gives that flexibility to states while protecting patients and the federal taxpayer.”

According to Cassidy’s website, states would have “significant latitude” with utilizing block grants, funds for which would derive from federal money that is currently spent on Medicaid expansion, ACA tax credits, the basic health plan, and cost-sharing reduction payments. State-based allocation will be determined by the amount that state residents now receive from these federal sources. By 2026, each state would receive the same amount of money for each beneficiary who falls within 50% to 138% of the federal poverty line.

A second Republican-sponsored effort at healthcare reform is HR 3725, introduced by Ways and Means Health Subcommittee chairman Congressman Pat Tiberi (Ohio) and Congressman Michael C. Burgess (Texas). HR 3725 would amend the Internal Revenue Code to repeal the individual health insurance mandate.

Meanwhile, Senator Bernie Sanders (I-Vermont) introduced S 1804, a bill to create a federally administered single-payer healthcare program that would cover all Americans. According to Sanders’ website, the $1.38 trillion annual plan would be funded via levying a 6.2% income-based healthcare premium on employers and a 2.2% income-based premium on households. The plan also calls for changes to income, capital gains, and estate taxes.

“We outspend all other countries on the planet and our medical spending continues to grow faster than the rate of inflation. Creating a single, public insurance system will go a long way towards getting health care spending under control,” said Sanders.

Finally, bipartisan efforts to stabilize the ACA insurance marketplace continued this week with 2 additional hearings before the US Senate’s Committee on Health, Education, Labor, and Pensions (HELP). The HELP Committee heard from a variety of stakeholders, many of whom emphasized the need for lawmakers to act swiftly to stabilize the market and provide certainty to insurers.

However, Senator Lamar Alexander (R-Tennessee) signaled that bipartisan progress may have hit a roadblock. "I could caution members that there still are significant differences to deal with," said Alexander. "A true compromise requires Democrats to accept something Republicans want—more flexibility for states—and Republicans to accept something Democrats want—continued funding for cost-sharing payments."