Tag: Affordable Care Act

Blog Posts (16)

February 10, 2017

The Affordable Care Act: It will not depart the same way it entered.

By Kathy Greenlee, JD
I recently learned the Irish superstition that you should exit by the same door through which you entered. The Affordable Care Act will most likely not have that option. The door it entered is closed.
I also recently revisited the unusual circumstances that allowed the ACA to become law. In early 2010, the Democrats held a 60-vote majority in the United States Senate. Then, in August, Massachusetts Senator Ted Kennedy died. In the election for his successor, Massachusetts elected Scott Brown, a Republican. Between the November election and Scott Brown’s swearing in, the Senate approved the ACA. When Senator Brown took office, the Democrats lost their super majority. The House had already passed the law, so they quickly moved to pass the Senate bill.

Having 60 votes in the United States Senate is a big deal. The Senate rules are such that the chamber requires a supermajority – 60 votes – to cut off debate and take a bill to the floor for vote.

Law, Regulations and Money

The ACA is anchored by three things: the law, regulations and money. Currently, the Republicans have a majority but not a supermajority. They don’t have 60 votes to pull the law off the books. They do, however, have enough votes to control the money. The ACA will be made ineffective and inoperable because the funds needed to make the law work will be removed. Money supports the subsidies for qualified people who purchase insurance through the exchanges. Federal money is used to match state money for Medicaid expansion and long term care rebalancing incentives (incentives for states to purchase community rather than institutional services for long term care). It takes money to close the Medicare prescription drug plan donut hole.

The first and most active battles in Congress will focus on money. And that battle has begun. The current 2017 federal fiscal year began on October 1, 2016. But, Congress has not passed a budget for this current year. Congress intends to use the current budget to gut the provisions of the ACA that are budget related. Then, immediately thereafter, the Trump administration will present Congress with a proposed 2018 budget and Congress will begin to work that budget this summer. The ACA will likely remain on the books, but won’t be operable as a comprehensive law. The non-budgetary sections will remain but will be largely inert.

While Congress assures the money dries up, the Trump Administration can begin the process of rolling back the thousands of pages of regulations that support the implementation of the law. Repealing regulations is time and labor intensive. ACA regulation repeal will be a steady slog likely to drag on through most of 2017 and into 2018. Regulations are behemoths.

Democratic Allies Needed

As you watch events unfold, keep in mind the three anchors I mentioned earlier: the money, the regulations and the law. The Republicans in Congress and in the White House will drive the budget and the regulations. They won’t need Democratic support to do so. But, to pull the remnants of the law and to pass a new law, Senate Republicans will need to find Democratic allies to help them get the 60 votes they need to cut off debate and pass legislation. The Democrats had 60 votes when the ACA passed; the Republicans currently do not. The 60-vote door will have to be unlocked in order to make new law.

Next up: Let’s talk in more detail about an ACA budget hot topic: Medicaid.


Kathy Greenlee joined the Center’s staff as Vice President for Health Policy and Aging in November 2016 after serving the past seven years as Assistant Secretary for Aging in the U.S. Department of Health and Human Services.



January 17, 2017

The Future of Health Insurance May Look A Lot Like Our Past

by Craig Klugman, Ph.D.

This week marks the transition of power from President Obama to President-elect Trump. One issue that has been high on Trump’s list of policy changes is a repeal and replace of the Affordable Care Act (a.k.a.…

January 4, 2017

Last Days of the ACA

by Craig M. Klugman, Ph.D.

Politicians are notorious for making campaign promises and then not carrying them out. With the beginning of the 115th Congress, the GOP has doubled-down on its promise to repeal the Affordable Care Act (aka “Obamacare”).…

August 24, 2016

The Tyranny of Corporatized Health Care: Time for Single-Payer

by Craig Klugman, Ph.D.

In Illinois, Land of Lincoln insurance and Aetna announced that they are pulling out of the health insurance Marketplace.…

March 16, 2015

How Screwed is North Carolina if Supreme Court Rejects Obamacare?

In a few months, we will find out whether the Supreme Court has decided that a critical part of the Affordable Care Act is unconstitutional. If that happens, lots of people will be in lots of trouble, financially speaking. Here … Continue reading

The post How Screwed is North Carolina if Supreme Court Rejects Obamacare? appeared first on PeterUbel.com.

February 24, 2015

Podcast on Healthcare.gov 3.0

The Managing Editor of the New England Journal of Medicine interviewed me about the piece I wrote, with David Comerford and Eric Johnson, on redesigning the health insurance exchanges. For those of you with long commutes, here is that podcast: … Continue reading

The post Podcast on Healthcare.gov 3.0 appeared first on PeterUbel.com.

February 23, 2015

More on Healthcare.gov 3.0

Here is a nice follow-up story on my recent New England Journal article on improving the design of health insurance exchanges. Comparing health insurance plans – whether signing up through Healthcare.gov or weighing employer-sponsored plans with a spouse – can … Continue reading

The post More on Healthcare.gov 3.0 appeared first on PeterUbel.com.

December 4, 2014

Obamacare 2.0—Better than Version 1.0?

Paige Rentz, an excellent reporter at the Fayetteville Observer, recently posted a question and answer piece, exploring some of the pressing issues facing the second round of insurance enrollment, on the Obamacare health insurance exchanges. I suggest you look at … Continue reading
October 7, 2014

Don’t Blame Obamacare for Health Insurance Turnover

When the health insurance exchanges began operating last year, critics complained that people were being forced out of their insurance plans. They correctly pointed out that Obama was mistaken to promise that “if you like your healthcare plan, you will … Continue reading
July 29, 2014

The D.O. Is in Now

[The New York Times] The old Blumstein’s department store sits across 125th Street from the legendary Apollo Theater. It’s something of a Harlem landmark, where “don’t buy where you can’t work” protests led to the hiring of African-Americans as the first salesclerks in 1934 and where the Rev. Dr. Martin Luther King Jr. was stabbed […]

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News (1)

May 17, 2012 9:33 am

Immigration status is a health policy challenge (Politico)

The Obama administration’s drive to cut down on America’s uninsured is about to get multilingual. Come 2014, when core provisions of the Affordable Care Act kick in, millions of legal immigrants will have new options for gaining health coverage. And like U.S. citizens, most will be subject to the individual mandate, under which they will be required to get coverage to avoid a penalty.