I was surprised this week to read that a lot of Americans think Congress repealed Obamacare this summer.
It is easy to understand why people are confused- even with my full-time gig keeping an eye on how Washington is affecting health care I found it challenging to keep track.
The status of the Affordable Care Act comes to mind particularly this week, as we pass the one-year anniversary of the election of Donald Trump and a fully GOP controlled Congress.
So here is a (partial) timeline of what happened in health care since Congress and the Trump Administration started in January.
Hold on! It has been quite a ride.
January 20th: Inauguration of Donald Trump. After the balls and at approximately midnight he signed his first Executive Order which instructed regulators to remove “burdensome Obamacare penalties”
January 24th: GOP House of Representatives is reviewing four different proposals to Repeal and Replace Obamacare
February 14th: Senator Rand Paul reportedly walks out of a meeting with members of the House of Representatives regarding the future of Obamacare, presaging disputes between the House and Senate to come
February 16th: IRS announces it will not withhold tax refunds for people who do not comply with the ACA mandated insurance information on tax forms
February 28th: Speaker Ryan dismisses reports that there are unwieldy divisions within the GOP regarding the Repeal and Replace Bill
March 7th: The House releases its Bill to “Repeal and Replace” Obamacare. The Bill is commonly attributed to Speaker Paul Ryan
March 9th: Democratic Leaders in the Hose and Senate start fight over the label “Trumpcare” for the newly proposed legislation in the House
March 13th: Paul Ryan’s bill in the House “Hangs in the Balance” as infighting between factions of the GOP grow
March 22nd: The most conservative branch of the House- the Freedom Caucus– announces its demands to support the Repeal and Replace Bill in the House
March 24th: Speaker Paul Ryan admits defeat on the House “Repeal and Replace” effort, declaring: “Obamacare is the law of the land. It’s going to remain the law of the land until it’s replaced”
April 4th: Paul Ryan “tamps down” news that there may be another attempt to Repeal and Replace in the House of Representatives
April 12th: President Trump tells the Wall Street Journal that he will stop subsidies to insurance companies participating in the ACA Exchanges if Democrats don’t come to the table to negotiate the “Repeal and Replace” legislation (with the anticipated result of chaos in the insurance industry)
April 14th: Trump Administration [CMS] announces final rules to stabilize the insurance industry
May 4th: House passes the American Health Care Act. Victory party with President Trump in the Rose Garden
June 13th: Trump calls House version of Repeal and Replace “mean”
June 16th: A bipartisan group of Governors criticizes the House cuts to Medicaid
June 22nd: The Senate bill to Repeal and Replace Obamacare is revealed after weeks of speculation as it is drafted with great secrecy. Four conservative Senators immediately announce their opposition
June 28th: GOP infighting over Senator Mitch McConnell bill “erupts”
July 15th: Bill is suspended by Mitch McConnell as his revised bill already has two “No” votes and Senator John McCain leaves Washington for unexpected brain surgery
July 18th: Senators Lamar Alexander and Patty Murray initiate bipartisan hearings for Congressional action to stabilize the insurance industry (particularly if President Trump stops subsidies)
July 25th: Senator John McCain returns to the Senate Floor and casts vote necessary to keep the Senate Bill to Repeal and Replace Obamacare alive
July 26th: Ten Bipartisan Governors ask Senate not to pass latest version of “Repeal and Replace”
July 28th: With a thumb down John McCain kills the third proposed alternative Senate Bill in the wee hours of the morning
August 23rd: Trump links Federal Budget, the boarder wall, and threats to stop subsidies to insurance companies participating in the ACA Exchanges
September 7th: The Graham-Cassidy Bill is introduced in the Senate as a “last-ditch” effort to get a bill passed in the Senate
September 10th: On “60-Minutes” former White House Chief Strategist Steve Bannon says the Congressional GOP leadership had promised the White House they could Repeal and Replace Obamacare “by Easter”
September 13th: Bernie Sanders files his “Medicare for All” bill in the Senate
September 26th: Senate attempts to Repeal and Replace Obamacare suspended “indefinitely” as head count reveals GOP can’t pass latest Bill [Graham-Cassidy] with the 50 votes necessary
October 6th: The Trump HHS and Justice Departments work together to roll back the contraception mandate in Obamacare
October 12th: President Trump signs an Executive Order that allows cheaper insurance on the Exchanges, cuts the Obamacare advertising budget by 90%, and significantly reduces funding for ACA Navigators, which he characterizes as “”starting that process to repeal Obamacare”
October 12th: In a “surprise late-night announcement” President Trump announces he is stopping subsidies to the insurance companies participating in the ACA Marketplaces
October 13th: 18 states (including 6 with Republican Governors) and D.C. sue to stop President Trump from stopping subsidies to the insurance companies participating in the ACA Exchanges
October 17th: Senators Alexander and Murray announce an agreement has been reached in their Bipartisan Committee to maintain subsidies to insurance companies participating on the ACA Exchanges (which, if passed, would negate President Trump’s announcement of October 12th)
October 19th: It is announced that there are now 24 sponsors of the Alexander-Murray Bipartisan solution to the insurance subsidy issue- with all Democrats in favor and currently 12 Republican supporters the bill is potentially “unstoppable” in the Senate
October 23rd: IRS changes position from 2017 and says it will not process forms for Americans that do not provide ACA mandated insurance information on their form
October 25th: Judge hearing suit from 18 states and DC on issue of insurance subsidies denies request to force Trump to continue subsidies to insurance companies pending full trial on issue
October 31st: CMS releases new rule that will allow states “wide latitude” in carrying out the ACA’s “essential health benefits,” undermining the law and bringing up a major sticking point for the GOP in the summer’s failed attempt to pass “Repeal and Replace” in the Senate
November 5th: Paul Ryan (on Fox News Sunday) announces that the pending Tax Reform Bill in the House may include a repeal of the Obamacare insurance mandate
November 7th: The GOP in the House appear to have backed off the idea to include repeal of the Obamacare insurance mandate in tax reform legislation
- The Affordable Care Act is still “the law of the land” (translation: Obamacare was not repealed);
- The Trump administration has weakened enforcement of the law through multiple Executive Orders as well as Executive Branch rules & regulations. These actions include (but are not limited to) reducing tax enforcement of the Individual Mandate (although the IRS seems to be reversing course on that), cutting money for marketing and ACA Navigators, and rolling back the contraception mandate;
- The October 31st CMS rule allowing States to undermine the “Minimum Health Benefits” requirements of the ACA will significantly affect people with preexisting conditions who want coverage at a fair price, as well as maternity care, and mental health benefits;
- A vote on the Alexander-Murray Bipartisan agreement to continue subsidies to insurance companies participating on the ACA Exchanges is expected in December, the future of that bill in the House is unclear, and Trump has issued conflicting statements about his support (or lack of) since October 17th;
- The bipartisan suit from 18 states and D.C. to maintain the insurance subsidies will continue to work its way through the judicial system;
- Conservative members of Congress and Donald Trump are signaling they will start on “Repeal and Replace” of Obamacare again in 2018;
- Election Day 2018 is on Tuesday, November 6th
Want To Know More?
I am frequently asked hot I keep up with Washington. Here are some of my favorite free resources:
- http://www.healthleadersmedia.com/ [HLM Daily News]
- The Hill: http://www.email.thehill.com/thehillreg/thehillreg/pref.action
- The Washington Post “Power Post Health 202”: https://subscribe.washingtonpost.com/newsletters/#/bundle/health202?method=SURL&location=ART
- modernhealthcare.com [subscription required]
If you really want excellent daily reporting on any issue in health care in America, I highly recommend a membership to the American Health Lawyers Association* [AHLA.org] which includes an extensive daily summary of headlines in health law nationwide with links to access the original sources., It is well worth the price of membership!
* The American Health Lawyers Association is the nation’s largest, nonpartisan, 501(c)(3) educational organization devoted to legal issues in the health care field with nearly 14,000 members.