How to Repeal and Replace Obamacare under a Trump Administration

Background: Republicans promised the American people a full repeal of Obamacare dating back to 2010, when the health care law was first passed. In fact, since Republicans took control of the House in 2010, Congress voted over 60 times to repeal parts or all of the law. Republican Congressional Leadership and President-elect Donald Trump have all promised to repeal this unaffordable, unworkable, and unfair law.

In 2015, Congress used a filibuster-proof process known as budget reconciliation to pass an Obamacare repeal bill (H.R. 3762), that was ultimately vetoed by former President Barrack Obama in 2016. Now that the American people voted to keep Republican majorities in both chambers of Congress and give Republicans the White House, Congress must act immediately to repeal Obamacare once and for all. There are no more excuses.

Obamacare “Two Budget” Repeal Strategy: Just as they did in 2015, Republicans should use budget reconciliation to repeal Obamacare. Budget reconciliation allows Congress to pass legislation with a simple majority in order to avoid a filibuster in the Senate. Ironically, Democrats used this same method to help pass parts of Obamacare in the first place. Due to conservative opposition, Congress failed to pass a budget for fiscal year 2017, creating an opportunity to pass two budgets, each with reconciliation possibilities, this year.

In the first budget, Congress should include the full repeal of Obamacare. This budget should pass the House and Senate easily and be placed on President Trump’s desk for his signature soon after he takes office. The next best option would be for Congress to take the reconciliation bill that repealed Obamacare, but was vetoed earlier last year (H.R. 3762), and pass it again with additional language repealing the Obamacare insurance mandates – a central reason health insurance premiums continue to rise. The third and minimal option would be for Congress to simply re-pass H.R. 3762, which does not include the repeal of insurance mandates and other important provisions. Repealing Obamacare does not mean that individuals on the federal and state Obamacare exchanges would immediately lose their health care plans. Instead they would have an ample period of time to transition back to an insurance plan on the individual market without losing coverage.

Congress should then pass the normal budget for fiscal year 2018 that lowers spending levels and includes other conservative priorities. This will give Congress time to work on an Obamacare replacement plan that restores consumer choice, strengthens the doctor-patient relationship and lowers costs. Replacement reforms Congress should consider include improving and expanding health savings accounts, removing government barriers that stop patients from participating in direct primary care arrangements, allowing patients to buy health insurance across state lines, and equalizing the tax treatment of health insurance for individuals and businesses, among others.

Obamacare Repeal Timeline Slipping: This January, Congress took an import first step to repeal Obamacare by passing the FY 2017 “shell” budget resolution (S. CON. RES. 3). Heritage Action key voted “Yes” on the resolution since it’s “the only way to expedite the repeal of Obamacare.” This resolution begins the process of budget reconciliation by setting up instructions for the House Ways & Means Committee, the House Energy & Commerce Committee, the Senate Finance Committee, and the Senate Health & Education & Labor & Pensions Committee to write a budget reconciliation bill that repeals Obamacare. Once the bills pass out of their respective committees they move to the Budget Committee. The Budget Committee then passes one unified repeal bill which the House and the Senate can then pass with a simple majority and President-elect Trump can sign into law.

Unfortunately, despite passing the budget resolution in early January, Congress has still not written the budget reconciliation bill repealing Obamacare. Seven in ten Americans believe the longer Congress waits, the less likely Obamacare repeal becomes a reality. Congress cannot allow the timeline to continue to slip. Not only does it delay work on other legislative priorities, but millions of Americans are suffering from the harmful side effects of Obamacare as premiums and deductibles continue to rise and health insurance choice falls.

Conclusion: Some repeal proponents assume Republicans must have a replacement plan at the same time as repeal, but this ensures momentum for full repeal stalls. Republicans may have a difficult time agreeing on any one single replacement plan, and Democrats will refuse to negotiate, instead doing everything in their power to sink the replacement plan and therefore Obamacare repeal.

Congress will use any excuse to avoid doing the right thing. As former Senator Jim DeMint and current President of the Heritage Foundation strongly wrote: “When I was in the Senate, they would use every excuse to avoid fighting for conservative priorities. “Wait until we get the House.” Done. “Wait until we get the Senate.” Done. “Wait until we get the White House.” Done and done. There are simply no alternatives left but to repeal Obamacare and win the fight (a shocking prospect for some!)”

Members who truly want to repeal Obamacare must insist on repeal immediately. This proposed two-step process gives Republicans the best chance to repeal Obamacare and honor their commitment to the American people who put them in power while providing plenty of time to enact a replacement plan. Conservatives must continue to urge their member of Congress write and pass the budget reconciliation bill to repeal Obamacare as soon as possible.

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Heritage Action Memo: How to Repeal All of Obamacare by Inauguration

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To:            Interested Parties
From:       Heritage Action for America
Date:        December 5, 2016
Subject:   How to Repeal All of Obamacare by Inauguration

Republicans have promised voters a full repeal of Obamacare since 2010, when the health care law was first passed. In fact, since Republicans took control of the House in 2011, Congress voted over 60 times to repeal parts or all of the law. Republican congressional leadership and President-elect Donald Trump have all promised to repeal the law.  

There are no more excuses to be had. The Republican-controlled Congress has every tool that it needs to overcome any and all obstacles that stand in the way of fully repealing Obamacare. Now that voters have given Republicans control of the House, Senate, and the White House, this campaign promise can and must quickly become reality and the American people should hold them, and President-elect Trump, accountable for delivering on that promise.

In fact, it is entirely possible for the Republican Congress to have a bill fully repealing Obamacare on President-elect Trump’s desk by the time he takes office on January 20. This memo outlines the path that Congress can take over the next two months to ensure a bill repealing Obamacare is the first thing President Trump signs – and that he signs it on Inauguration Day.  

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Memo: How Congress Can Stop the Impending Obamacare Bailouts

To:              Interested Parties
From:        Heritage Action for America
Date:          October 18, 2016
Subject:     How Congress Can Stop the Impending Obamacare Bailouts

There is widespread agreement that Obamacare is on the verge of collapse, and while that should prompt calls for full repeal, the reality is that many in Washington are instead contemplating how the law can be propped up.  Much of this will play out in 2017 and beyond with a new administration and a new Congress, but some of it will come to a head in the last two months of 2016.  In fact, a multi-pronged taxpayer bailout of Obamacare could be in the works. Fortunately, Congress can take three relatively easy steps to stop this from happening. It needs to 1) allow temporary programs to expire as scheduled; 2) reassert current law that has previously been signed by President Obama, and 3) block illegal payments.

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Excessive Suspensions Raise Conservative Concerns

Avoiding Accountability

This week the House of Representatives is expected to pass a large number of bills (49) under the suspension of the rules, a procedural mechanism that allows Leadership to fly through the consideration of legislation, potentially even passing the bills by voice vote (which avoids accountability to their constituents). If a bill considered under suspension of the rules ends up receiving a recorded vote, it requires a 2/3 majority to pass, as opposed to the typical simple majority. Because of the higher threshold for passage, Republican House Leadership must secure Democrat votes for these bills. Legislation considered under suspension should not make any substantial policy changes or incur significant costs to the taxpayers. Unfortunately, many of the bills on the suspension calendar regularly violate these principles, and this week is no exception; in fact, it is worse than most.

Through A Terrible Process

The process of underlying the bills being considered this week falls short of at least four main reasons:

  1. Considering almost 50 bills under the suspension of the rules avoids accountability and is an irresponsible way to govern. Most Members of Congress and their staff do not have time read each one of these bills, and even if they did, if the bills pass by a voice vote (which is often the case), constituents have no record of how their Representative voted on most of these bills.
  2. The Republican controlled Congress should be focused on more pressing matters, such as fighting for a conservative spending bill that avoids a lame duck session of Congress. Spending two days passing legislation that is meaningless at best, and liberal at worst, with Democrat support is an example of misplaced priorities.
  3. Many of the bills were scheduled for a vote before they had a Congressional Budget Office score available. While some of the scores may be made available later, Members of Congress and their staff will not have adequate time to fully grasp how much the legislation would cost and whether or not it would add to the debt or deficit. Furthermore, this violates the Majority Leader’s Floor Protocols.
  4. On the schedule are a number of Democrat bills from members who actively participated in the “sit in” that violated House Rules. This means that Democrats are being rewarded who broke House rules regarding decorum and behavior of Members of Congress.

Results In Bad Policy

Of the 49 bills on suspension, conservatives should be particularly opposed to two:

  1. H.R. 670, the Special Needs Trust Fairness Act, offered by Rep. Glenn Thompson (R-PA). The bill expands Medicaid, uses budgetary gimmicks, and provides $24 million for a slush fund at HHS. Along with creating a new $11 million Medicaid program to help women in post-pregnancy to quit smoking (even though it only has an expected 10% success rate), it appropriates an additional $24 million over two years (2020-2021) into the Medicaid Improvement Fund (a slush fund) and uses a budget gimmick (temporarily ending Medicaid payments for hair growth drugs like Rogaine) to offset the expansion of special needs trusts to non-elderly individuals with disabilities. Medicaid needs reform, not a piecemeal expansion of eligibility or benefits. The bill’s approach only undermines an already vulnerable program.
  2. H.R. 5859, the Community Counterterrorism Preparedness Act, offered by Rep. Michael McCaul (R-TX). This bill creates another new (and duplicative) federal grant program for counterterrorism training in major metropolitan areas and also authorizes $195 million for its implementation. This is despite the fact that earlier this year the Department of Homeland Security announced Fiscal Year (FY) 2016 Notices of Funding Opportunity for ten DHS preparedness grant programs totaling more than $1.6 billion. Furthermore, this bill brings back echoes of the failed Countering Violent Extremism policy promoted by the Obama Administration, DHS, and the Homeland Security Committee. Like other bad CVE bills Heritage Action has opposed, H.R. 5859 contains no effective prohibition against funding groups like CAIR, and other unindicted co-conspirators from the Holy Land Trial, or other potential Muslim Brotherhood front groups, or from receiving the grants and participating in the “community outreach.”

A Republican Congress should not be legislating through an expedited process that obscures transparency and grows government with little to no accountability. House Republicans should ensure that all 49 of these bills receive a recorded vote, evaluate each bill on their merits, and especially ensure that these two bills receive recorded votes and then vote against them.

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Postal Service Bailout: Claims and Responses

On July 12, 2016, the Oversight and Government Reform Committee (OGR) rushed to pass legislation bailing out the U.S. Postal Service (USPS)—the so-called Postal Service Reform Act (H.R. 5714)—without a cost estimate from the Congressional Budget Office (CBO) or a recorded vote. In the process, OGR released a rebuttal document in response to Heritage Action’s statement of opposition. The following are responses to those rebuttals.

 Rebuttal #1: “There is a lot for Conservatives to like in this bill. H.R. 5714 treats the Postal Service more like a private sector business. The bill cuts Postal Service costs while also taking away the strongest anti-reform argument: that the agency is only struggling because of an ‘unfair’ retiree health care requirement.”

Response: There is a reason liberal Democrats and USPS support H.R. 5714. It rewards the Postal Service, and its constituencies, with their number one priority for years—relief from their current health care contributions in exchange for few reforms. In fact, it is the important reform principle established in 1971 that USPS should be treated more like a business—responsible for both its assets and liabilities—that is grounds for opposition to the bill. The bill shifts liabilities to taxpayers.

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