ACA's Repeal, Replace, and Repair

Abstract

On his first day in office, President Donald J. Trump directed via Executive Order that federal agencies should “waive, defer, grant exemptions from, or delay” enforcement of provisions of the Patient Protection and Affordable Care Act (ACA) that impose fiscal burdens. However, in an early exhibition of political restraint, President Trump and the Republican-led Congress have not yet fully repealed the ACA, despite promises to do so – and fast. It may have taken decades for multiple Presidential administrations to develop comprehensive health care reform, but only one administration to effectively undo it. To be sure, the ACA is on legal life support. The only reason that its shelf-life has been extended may be the recognition that replacing “Obamacare” is not so easy. Americans have developed a love-hate relationship with the ACA. They love the assurance of health coverage despite pre-existing conditions, but hate they are mandated to get covered. They love how their dependents can remain on their insurance policies until age 26, but hate how those policies’ premiums have risen over years. They love how the ACA extended coverage to 20 million Americans who previously lacked it, but hate that such care is subsidized by new taxes, penalties, and other revenues.

Jettisoning undesirable provisions of the ACA while retaining what works is complicated. Replacement options are percolating across the aisles of Congress and throughout the states. Some proposals would initiate the repeal of the ACA in its entirety. Others seek to repair what is deemed broken without trashing the entire act. Most of the proposals provide patchwork fixes. Some present more comprehensive replacements.

Keywords: ACA, repeal, replace, health care access, coverage, insurance