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Congressman Ralph Abraham

Representing the 5th District of Louisiana

Column: Why Obamacare Repeal Must Come with Replacement

March 29, 2017
Press Release

America is at a crossroads with our health care system. We’ve got three choices: 1) keep Obamacare, 2) repeal Obamacare without a replacement plan, or 3) repeal and replace it together.

I’ve spoken at length about the need to repeal Obamacare. It’s the central issue I campaigned on when I first ran for Congress. As a rural doctor, I’ve watched my patients be priced out of access to health care because they can’t afford the premium hikes (nearly 32 percent on average this year in Louisiana) and their outrageous deductibles. They’ve seen their choice of insurers dwindle to almost no choice at all as 68 percent of counties in the United States have two providers or fewer. Meanwhile taxpayers have seen $1 trillion in new taxes, most of which hit lower and middle income families the hardest.

Keeping Obamacare is simply not a viable option.

Option 2 - Fully repealing Obamacare only, without replacing the current broken system, is a position that some constituents have called, emailed, and spoken to me about. Others have suggested that Congress should first repeal Obamacare immediately and then let Congress work on implementing a replacement down the road. I share their passion to rid our nation of the terrible policy that is Obamacare, but I must caution that a repeal without replacement presents a number of challenges that could cause disastrous problems throughout the nation.

First, Obamacare is not a single entity that can be swapped out like a new spark plug to keep the health care system’s engine running. More accurately, it is a concept that describes 8,000 pages of laws and regulations that deal with everything from numerous types of taxes, employer regulations, the handling of Medicaid, the establishment of insurance exchanges, and reimbursement rates for doctors and hospitals.

A complete reset of all those different aspects of the system could cause dramatic instability in our financial markets. It could throw funding mechanisms for hospitals and medical clinics into chaos, resulting in closures and risking access to health care for all of our families. 

But it would also have a very real effect on patients. The Congressional Budget Office estimates that repeal without replace would result in 18 million people losing insurance overnight, and that number will grow to 32 million within 10 years. Premiums are expected to double within 10 years, so a central goal of repealing Obamacare would not be accomplished. 

Everyone who lost insurance when their employers dropped coverage due to Obamacare’s expenses would then lose coverage again if their exchange plan was eliminated overnight. 

It would also mean millions of people with preexisting conditions would not only lose current coverage, but they’d no longer have affordable access to the health care at all. I cannot in good conscience support a plan that does not provide an alternative process for a cancer patient who now has access to treatment.

Medicare costs could also increase, and Medicare patients would see the reopening of the dreaded doughnut hole.

The effects of repeal without a replacement mechanism are bad enough, but there’s also the political reality that it could never get done in the current divided Congress. While I disagree with the Senate’s bizarre and antiquated filibuster rules that require 60 votes to move a bill, it is nevertheless a reality of the world we live in. A straight forward repeal with no replacement would never get the necessary votes in the Senate because Republicans only control 52 seats, and Democrats are desperate to save President Obama’s legacy legislation.

I joined a majority of House Republicans and President Trump last week in supporting the American Health Care Act. President Trump believed this bill was a critical step toward keeping our Republican promise of repealing and replacing Obamacare, but unfortunately this approach was unsuccessful due to some Republicans joining with Nancy Pelosi and the Democrats to block what President Trump and I believe was the smartest approach to repealing Obamacare.

The only way around the filibuster is to use a process call reconciliation. It can only be done with items concerning the budget and it can only be done once a year – when the budget is being written and this was the path we tried to take most recently with the AHCA.

Using reconciliation would have allowed us to leverage the Republican majorities the American people gave us in the House and Senate so that we can put a bill on President Trump’s desk. Had the AHCA passed, it would have repealed the un-American mandate requiring every person to buy insurance or pay the IRS a penalty. It would have removed billions in Obamacare taxes that are hurting our small businesses and stifling economic growth. It would have allowed us to defund the abortion provider Planned Parenthood. It would have allowed us to make the largest deregulation and structural reforms in history to Medicaid, giving states more flexibility in delivering affordable healthcare more efficiently while allowing states to decide things like whether those receiving Medicaid should be required to work and drug tested. And it would have paved the way for comprehensive tax reform, one of President Trump’s top goals.

We couldn’t pass everything we wanted with the reconciliation process - such as selling insurance over state lines and providing for more transparency in drug and medical pricing - because the Senate would have ruled the bill out of order. But non-budget related reforms such as this could have been implemented administratively through President Trump’s administration. All of this would unilaterally scale back regulations if Congress provided the flexibility to do so by passing the AHCA. Additional reforms would still be needed, which admittedly might be challenging to pass without the reconciliation process. Again, the strange rules of the Senate are frustrating, but they are also a reality we have to live with as we try to govern.

Though the AHCA was not a perfect bill, it provided for the structures and path I believe we needed to repeal Obamacare and reform the health care system.

Those of us in Congress must be willing to tackle difficult problems like this because we were sent to Washington to govern. We cannot let the perfect get in the way of the good. Obamacare is collapsing, and doing nothing is a march toward nationalized health care. Despite these setbacks, I remain optimistic that my colleagues will put partisan politics aside and do what is right. I will never give up, as the status-quo is simply unacceptable.