President Trump, along with other Republican lawmakers, have promised to “repeal and replace” the Affordable Care Act (ACA). But it hasn’t happened yet. Here’s why, as well as a timeline for what’s to come. 

In his “Contract with the American Voter,” Donald Trump promised to repeal Obamacare within his first 100 days in office. But the reality is he can’t do it on his own. He needs votes to get it repealed outright — and he doesn’t have enough of them.

What’s the hold up?

Broad legislation that would repeal the ACA would require 60 votes in the Senate, and the GOP doesn’t control enough seats to make that a reality — or avoid a filibuster by the Democrats.

Still, that hasn’t stopped Trump from declaring war on the healthcare reform law. In one of his first acts as president, Trump issued an executive order that directs federal agencies to waive some of the requirements of the law that could impose a burden on individuals and certain businesses.

It was a clear sign from Trump that his administration plans to attack the ACA by any means necessary.

So what’s the plan now?

Congressional Republicans are now preparing to dismantle portions of the ACA using a process known as reconciliation. It will allow the GOP to vote on budgetary pieces of the health law, without giving the Democrats a chance to filibuster.

The problem for Republicans is reconciliation limits the extent to which they can reshape the law.

Parts of the law it appears they can roll back through reconciliation:

  • The individual mandate (which is imposed through a tax)
  • The employer mandate (which imposed through a tax), and
  • The subsidies to help individuals purchase coverage (which require government funding).

The Republicans believe that through reconciliation they can knock the legs out from under the ACA and begin to implement their own health reforms.

Some of the things members of the GOP have indicated they want to do:

  • Go to a more free-market approach, in which individuals would have greater ability to purchase health insurance across state lines
  • Expand health savings accounts
  • Allow individuals to deduct the cost of health insurance premiums from their income taxes, and
  • Let states manage Medicaid funds.

Two popular ACA provisions Republicans said they plan to keep in health plans:

  • The prohibition on denying coverage to those with pre-existing conditions, and
  • The ability for children to stay on their parents’ plans until age 26.

So when is it all going to happen?

When it comes to a timeline for when the GOP hopes to initiate reforms, things are a little murky. The problem is, due to the reconciliation process — and complaints from insurers about what the requirement to provide coverage to those with pre-existing conditions will do to risk pools and pricing — things aren’t as cut and dried as employers would like them to be.

But here’s what we know:

  • In late January, at its annual retreat, the GOP said it wants to bring a final reconciliation package to the floor of the House by late February or early March
  • In a pre-Super Bowl interview with Fox News’ Bill O’Reilly, President Trump said the repeal and replace process is “complicated” and could take until “sometime next year,” and
  • Just a few days after Trump’s statements to O’Reilly, House Speak Paul Ryan (R-WI) said the president’s remarks won’t alter the timeline for the House GOP to introduce significant repeal and replace legislation by the end of 2017. Still, Ryan did indicate that even if such legislation is passed, it could take some time for it to be fully implemented.

Bottom line: Employers are likely looking at a long legislative process, and an even longer implementation period.

Bills that could chip away at law

While Congress mulls larger-scale changes to the ACA, a few bills have been introduced for lawmakers to chew on.

The following could chip away at certain elements of reform:

  • The Middle Class Health Benefits Tax Repeal Act (H.R. 173) would kill the 40% deductible excise tax (a.k.a., “the Cadillac tax”) on high-cost employer health plans
  • The Health Savings Account Expansion Act (H.R. 247 and S. 28) would permit the reimbursement of health insurance premiums and increase the maximum allowable contribution, and
  • The Healthcare Tax Relief and Mandate Repeal Act (H.R. 285) would kill both the individual and the employer health insurance mandates.

Stay tuned. We’ll keep you posted on all things health reform.

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