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Experts Discuss What is Needed to Repeal and Replace the ACA

Feb 1, 2017 | Health Care

As Congress and the Trump administration continue to figure out how to go about repealing and replacing the Affordable Care Act (ACA or "Obamacare"), the Committee for a Responsible Federal Budget (CRFB) and Kaiser Family Foundation (KFF) convened two panels of experts on Tuesday to discuss challenges and principles to guide the deliberation. The event kicked off with remarks from KFF president and CEO Drew Altman and CRFB president Maya MacGuineas, who both shared the sentiment that health care reform is a formidable issue without simple answers and has potentially large fiscal consequences.

The first panel, moderated by CRFB senior vice president and senior policy director Marc Goldwein, discussed the principles for "repeal and replace" going forward. Stephanie Carlton of McKinsey & Company (formerly of the Senate Finance Committee Republican staff) noted that the ACA has been able to achieve significant reduction in the uninsured rate but hasn't had enough of an effect on cost control and price transparency, and Liz Fowler of Johnson & Johnson (formerly of the Senate Finance Committee Democratic staff) agreed and added that the ACA should be built upon in a fiscally responsible way that addresses its missteps without reducing coverage or raising premiums. Avik Roy of the Foundation for Research on Equal Opportunity shifted the conversation to discussing how to get a better value out of the U.S. health care system at a lower price, and he stressed that reform need not reduce coverage while accomplishing these goals. And Harold Pollack of the University of Chicago commented that there should be work done to make ACA subsidies more generous and that good policy might not necessarily equal good politics when it comes to solving health care cost issues.

The panel agreed in many areas, like making sure the ACA subsidies are structured correctly and limiting market distortions while encouraging innovation. However, they disagreed on whether the system was better now than before the ACA, with Fowler and Pollack saying it was much improved while Roy said it is even worse because of Medicaid expansion, and Carlton argued neither the pre-ACA or post-ACA status quo should be accepted as perfect. All four panelists agreed that there was certainly room for improvement from the current state of health care, but their approaches differed in magnitude and philosophy.

The second panel, moderated by KFF senior vice president for special initiatives Larry Levitt, focused on what a possible replacement plan could look like. Joe Antos of the American Enterprise Institute said any replacement should focus on cost control, which he noted was the area that the ACA failed and will be key moving forward. Peter Lee of Covered California suggested that the most important aspect of any replacement is financial help in the form of Medicaid expansion and age-, region-, and income-adjusted tax credits. Bill Hoagland of the Bipartisan Policy Center (and CRFB board member) noted that it would be very difficult to generate a replacement that reduces the deficit without focusing on price, which drives the cost issue of health care. Chris Jennings of Jennings Policy Strategies (formerly of the Obama administration) explained that there would be a tradeoff between coverage and benefits if a replacement were be deficit-reducing.

The panel participants disagreed on whether a replacement could reduce costs without reducing benefits, but they largely agreed on the idea that replacing the ACA would be an enormous lift that should be figured out before changes are made. Antos argued that there are lots of plans for replacement, but none have been detailed because it is a new political reality to move forward with "repeal and replace." Lee, Hoagland, and Jennings argued that the devil would be in the details, which would be much more difficult to figure out than the current replacement plans portray.

Watch the video from the event:

You can watch the full video here as well. For additional CRFB information on ACA "repeal and replace", check out these materials:

Or scroll through our Chartbook: Affordable Care Act "Repeal & Replace" Effects & Implications below: