Wilensky G. Republicans Will Own Whatever Happens to the ACA and Health Care Reform. JAMA Forum Archive. Published online September 19, 2017. doi:10.1001/jamahealthforum.2017.0043
As has become clear, “Repeal and Replace” of the Affordable Care Act (ACA), a mantra that provided such a unifying theme for Republicans when Democrats controlled the White House, has been much harder than Republicans expected when they achieved “full control” of the government. Republicans were barely able to pass a health care bill in the House despite their substantial majority over Democrats (240-194) and the Senate fell short of passing the so-called “skinny” repeal bill, HR 1628, which repealed only a limited portion of the ACA.
Because House Republicans had worked on a broad agenda for change in 2016 under the leadership of Paul Ryan, the challenge in the House was somewhat surprising—perhaps caused by the understanding that an affirmative vote for repeal was no longer merely symbolic but might become law. Moderates, who previously had supported their leadership, were uneasy by the Congressional Budget Office projection that up to 23 million more people would be uninsured within a decade as a result of the House legislation. Conservatives wanted even more of the ACA repealed than was possible with the constraints in the Senate, which was focusing on budget-related legislation that could be passed with a simple majority.
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Gail Wilensky, PhD Gail Wilensky, PhD, is an economist and Senior Fellow at Project HOPE, an international health foundation. Dr Wilensky previously directed the Medicare and Medicaid programs and served in the White House as a senior adviser on health and welfare...