ALTOONA — Perhaps the only sure thing when the U.S. Senate takes up health insurance reform this year will be that the final product won’t be a total repeal of the Affordable Care Act as some Republicans promised on the 2016 campaign trail, two GOP senators told Iowans Tuesday.
“It’s not going to be torn up by the roots in one piece of legislation,” U.S. Sen. Chuck Grassley, R-Iowa, told reporters after a congressional forum sponsored by the Altoona Area Chamber of Commerce. “It’s going to take two pieces of legislation to accomplish the goal.”
That’s because a full repeal would require 60 votes under Senate rules and Republicans only have 52, said Sen. Joni Ernst, R-Iowa, so they will have to use the Senate’s “reconciliation” process to “tinker around the edges” to repeal pieces of Obamacare they find the most objectionable while trying to protect Iowans who face the loss of individual health insurance options as private insurers drop out of the exchange.
“I wish that we could repeal it fully and figure out a different way forward,” Ernst told the gathering.
“We’re in a world of hurt right now. I wish we could go back in time. We can’t do that. All we can do is move forward with what we have right now,” she added.
Earlier this month, the U.S. House narrowly approved legislation to repeal and replace major parts of the Affordable Care Act, as Republicans moved a step closer to delivering on their promise to reshape American health care without mandated insurance coverage.
Last week the Congressional Budget Office released projections indicating that as many as 23 million Americans could lose their health insurance over the coming decade if the House-passed GOP health care bill becomes law. The comprehensive repeal bill would reduce the federal deficit by $119 billion over the same period of time, in part by rolling back the expansion of Medicare.
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The House bill would eliminate tax penalties for people who go without health insurance. It would roll back state-by-state expansions of Medicaid, which covered millions of low-income Americans and, in place of government-subsidized insurance policies offered exclusively on the Affordable Care Act’s marketplaces, the bill would offer tax credits of $2,000 to $4,000 a year, depending on age.
Grassley said Tuesday the Senate will write its own bill instead of working off the House version, which he told reporters “doesn’t do anything for the 70,000 Iowans that probably in a month won’t be able to go to the exchange and buy any insurance.”
Ernst said she is looking for options to deal with Iowa’s unique circumstance where private companies have opted not to participate in the government insurance exchange.
“One-size-fits-all from Washington, D.C., just doesn’t work, and it took us about four or five years to find out,” Grassley said. “We have to make sure that we have a program that is accessible and affordable for people.”
Ernst said the Senate approach she is pushing for would address the long-term concerns about Obamacare while providing a short-term “stop gap” measure to head off a potential crisis for some Iowans who may not be able to buy individual insurance policies for 2018.
Iowa may become the first state to lose all commercial companies selling individual health-insurance policies due to the uncertainty swirling around the future of Obamacare.
“Iowa is on the cliff,” Ernst said. “We are the No. 1 state in the United States when it comes to losing providers. That’s not a statistic that we want, but, unfortunately, we are there.”
One option might be using state innovation programs allowed under current federal law to craft an Iowa approach that would need CMS approval.
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Overall, she hoped the Senate approach would give private insurance companies greater flexibility in plan options and allow consumers to choose the plans that work best for them and their families.
She also hoped to preserve the pre-existing condition element of Obamacare while allowing insurers to absorb the cost by using reinsurance options or risk pools that they don’t currently have.
“Unfortunately, we’ve been handed a real big mess right with the ACA, and we can only do what the law will allow us to do through reconciliation,” Ernst said. “So, as much as I’d love to go back and scrap the whole darn thing, we’re simply not able to that at this moment, but we’ll continue to work on it and see can do to lower costs for everyone.”
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