As of Fall 2017, President Trump’s efforts to repeal Obama’s signature healthcare law, the Affordable Care Act, and replace it with something else have failed. Despite having control of the Presidency, the House, and the Senate, the Republican Party was unable to agree on a replacement health care law that satisfied all of their members. As a result, the Affordable Care Act is still in effect, at least for now, and Trump has shifted his focus to undermining the effectiveness of the law instead, with the intent of attempting to repeal it again later on.
Why Repeal And Replace Failed
There were several factors in the repeal and replace effort that caused it to fail. First of all, the debate between various Republicans showed that there were large disagreements within the party about how healthcare should work. In general, Republicans fell into two camps: moderates and conservatives. The Republicans tried several different versions of a replacement bill, but they could never satisfy both of these groups at the same time. The conservatives wanted to cut Medicare and Medicaid and minimize government spending, as well as lower taxes. The moderates preferred to give as many people health insurance coverage as they could and opposed cutting Medicare and Medicaid.
The second big factor was public opinion. Repeated public polls from the times before the bill came up for a vote showed that “Obamacare” had steadily increased in popularity among the general public since it passed in 2010 and “Trumpcare” was extremely unpopular. Many elected Republicans became concerned that if they voted for a replacement health care bill, its unpopularity would cause their constituents to vote them out of office in the 2018 or 2020 elections. The long debate and deep confusion among both politicians and the public about what Trumpcare actually contained only made matters worse. As time went on voting for Trumpcare became more politically dangerous, making the bill even harder to pass.
The secretive process of writing the reform bill also hurt its chances. There were several different bills proposed in both the House and the Senate, and each one went through many revisions and votes. But Republicans usually wrote the bills behind closed doors, giving each other and the public little time to read and understand them. By the end of the process, the senators going through the final vote had little idea about what they were actually voting for or what would happen on a “Yes” vote– it might result in a “skinny repeal” that made some basic changes to Obamacare or it could lead to a totally different law that Republicans in the House of Representatives wrote.
The Future
Republicans abandoned the health care reform push after the last Senate vote failed. Since then, the Trump administration has decided to try “letting Obamacare fail.” This means, for example, cutting back on advertising and instructions that tell people how Obamacare health insurance plans work and how to sign up for them, which could lead to a drop in enrollments. Medicare lawyer Dr. Nick Oberheiden warns businesses to remember that as of now, Obamacare rules and regulations are still in effect, so it is crucial to remain in compliance with current laws until further notice. For now, insurers have submitted their plans for 2018 with the assumption that the Affordable Care Act will remain in place for the foreseeable future. That could change for the 2019 policy year if the Republicans decide to make another attempt to repeal and replace the law or if the Trump administration manages to undermine the Obamacare health insurance markets. This could come from discouraging people to sign up for plans or from interfering with the distribution of subsidies. The Republicans will soon face several other legislative issues, from creating a budget to dealing with the debt ceiling and tax reform. It is unknown how long those might take, which makes it hard to predict when a new repeal and reform initiative might begin. Again, this means that the best course of action is to stay in compliance with the Affordable Care Act for now while monitoring the situation closely in case anything changes.