WHERE CAN THE ACA GO IN CONGRESS AND TRUMP WHITE HOUSE?
Statement by Bob Weiner, former Clinton and Bush White House spokesman, Chief of Staff of House Aging Committee (and Health Subcommittee), and communications director for House Government Operations Committee
Trump's push to allow negotiating with drug companies on pricing -- as all other countries do, and the VA -- which would save several billion dollars and is a good funding mechanism-- actually is a point of compromise. You remember that provision (then-Cong Rahm Emanuel's proposal) lost by one vote in the wee morning hours when ACA went through finally without it. Instead, ACA bans it, ridiculously but because of big pharma lobbying. Another one is tort reform so doctors aren't sued into bankruptcy for trying to do their jobs-- Obama wanted to include 5 model programs but D's wouldn't even allow that because of allegiance to the trial lawyers. Other mechanisms (and these two were mentioned by Pence) are HSA's and selling across state lines-- neither does that much but allowing-- not forcing-- them would be fine if we keep in mind they really only help couple million people and can't be used as excuses to drop money for the real numbers of the rest. So if D's want to save the 32 million now-newly insured people and the pre-existing conds, children on plans, no lifetime caps, prevention like mammograms and prostate exams etc., there are good ways to compromise. Trump has also said Medicaid is one way to assure poor people coverage-- so they may be inclined to let states keep the Medicaid expansion-- hospitals (a big R constituency) also are horrified they may not get that new Medicaid money they are getting and people could be forced back into ER's. And if R's get their way on HSA's and interstate sales they may allow the subsidies to keep the exchange program going too.
The other alternative -- and I'd say this is 50-50 what will happen instead of the complications above--is R's repeall with a two-or-three-year transition window and include an"outline" of proposals which means not real legislation, can't get the votes to replace because of opposition from right and left, and simply do CR's year by year just like the "doc fix" that kept happening on Medicare reimbursement rates for a dozen years, off-budget. That is a very likely scenario.