“Skinny Repeal”: The Next Phase of Operation “Repeal and Replace”

By Sabine Joseph

After several failed attempts to repeal and replace Obamacare, lawmakers tried yet again to implement health care reform on Thursday, July 27 with Senate Majority Leader Mitch McConnell’s proposed Health Care Freedom Act (HCFA), to no avail.

The HCFA, commonly known as the “skinny repeal”, was intended to strip some of the more unpopular aspects of Obamacare rather than repealing the bill entirely.

Lawmakers hoped that the bill would receive a minimum of 50 Senate votes, thereby acting as a way to open up a discussion between the Senate and the House so that a comprehensive health care bill would finally reach President Trump’s desk.

Though the “skinny repeal” was intended to serve as serve as a starting point and not a final destination, some GOP senators feared that the bill would be the end of the road for health care reform and that the House would hurriedly pass it simply to move on to tackling other issues like tax reform after so much time had been spent trying to repeal Obamacare.

With Democrats unanimously opposed and the slim 52-48 GOP majority divided, voting on the bill ran late into the night, but the “skinny repeal” ultimately failed.

However, many insurers, doctors, consumer advocacy groups, and health policy experts  would find success in that failure as they all argued against the HCFA on the basis that it could have destroyed the individual market. They say that premiums would rise and insurers would flee should key Obamacare provisions be repealed without proper replacement.

The numbers support them on this as the Congressional Budget Office estimated that premiums would increase 20% next year in comparison to current law. Additionally, it estimates that in 2018, 15 million more people would be uninsured in comparison to Obamacare, with that number expected to rise to 16 million in 2026.

Despite the bill’s failure, based on how the matter of repealing and replacing Obamacare has been handled over the past few months, it can be expected that the “skinny repeal” will simply be revised and that consumers may see these same goals brought up again in the future.

Therefore, here is the skinny on the “skinny repeal”:

 

Repeal the individual mandate:

The individual mandate, one of the most unpopular aspects of Obamacare, would be essentially repealed with the “skinny repeal” as the penalty for an individual not having insurance would be set at $0.

Unlike the previous House and Senate bills, the “skinny repeal” does not offer incentives for Americans to remain insured, an essential aspect of the health-care market, thereby raising the concern of insurance lobbyist groups, including America’s Health Insurance Plans, and a group of bipartisan governors who warn of rising premiums and insurance companies dropping out of the market.

Temporarily revoke the employer mandate:

The “skinny repeal” aims to unburden companies of the responsibility of providing affordable insurance for a minimum of eight years, while earlier House and Senate bills aimed to repeal the mandate entirely.

Allow states more flexibility:

Through eight-year waivers that the federal government cannot revoke, even if states use them to the detriment of residents, the “skinny repeal” would allow states more flexibility in implementing Obama-era insurance regulations.

The waivers would give states the power to manipulate certain aspects of health care, including the essential health benefits and the out-of-pocket spending limit. And despite the fact that they cannot be revoked, they come with stipulations: states cannot use the waivers to make people become uninsured, restrict benefits, or make coverage less affordable.

Defund Planned Parenthood:

The “skinny repeal” would achieve a controversial goal of the Trump administration to defund Planned Parenthood while also giving more money to Community Health Centers.

The bill would go a step further than past attempts in that it would defund similar providers as well, thereby adhering to the Senate’s rules for reconciliation, which the parliamentarian said the original bill — which applied only to Planned Parenthood — did not.

Community Health Centers-– which, during the 2017 fiscal year, cared for 25 million low-income patients at over 1,400 locations– would receive $422 million with the “skinny repeal” as per the House bill and the Senate’s original bill.

However, leftists argue that these centers could not cover the impact caused by the loss of Planned Parenthood, which has over 600 locations where 2.4 million Americans go to receive  sexual and reproductive health care services.

Temporarily revoke the medical device tax:

Opposed by both parties, another unpopular Obamacare mandate was the 2.3% tax on medical device manufacturers.

Though the House and Senate would have it repealed entirely, the “skinny repeal” bill would repeal it for only three years.

Temporarily Allow for more to be put into Health Savings Accounts:

As in the House and Senate bills, the “skinny repeal” will increase the contribution limit for HSAs, allowing people to put more money away for a period of three years.

Terminate the Prevention and Public Health Fund:

The Prevention and Public Health Fund is part of the Center for Disease Control and Prevention (CDC) and is responsible for investing in programs that improve public health and prevent cost growth.

According to the CDC, it promotes immunizations and supports the prevention of heart disease, strokes, diabetes and lead poisoning; however, critics claim that the Prevention is a slush fund used only for frivolities.

The Prevention provides the CDC with approximately 12% of the agency’s annual budget, around $1 billion, but with the “skinny repeal” Republicans in both chambers would get their wish of eliminating it.

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