House Republicans' plan to replace the Affordable Care Act would make significant changes to the U.S. health insurance system. But that's just the beginning.
"There are three phases of this plan," Health and Human Services Secretary Tom Price told reporters this week. And the bill now being marked up in House committees is just the first step.
That bill would repeal taxes on wealthy Americans, do away with a tax penalty on those who fail to obtain insurance, and adjust the rules governing insurance premiums so in general younger, healthy people pay less while older, sicker people pay more. The measure also makes big changes to Medicaid, beginning in 2020. And it adjusts the tax credits that people can use to buy health insurance on the individual market.
President Trump has other ideas for tweaking the health care system. But those would have to be achieved later, either through rule-making or future legislation.
"The previous administration used regulations to a fare-thee-well," Price said, adding the Obama administration issued 192 specific rules related to the Affordable Care Act. "We are going to go through every single one of those and make certain that if they help patients, then we need to continue them. If they harm patients or increase costs, then obviously they need to be addressed."
Regulatory adjustments are Phase 2 of the White House plan.
Phase 3 involves going back to Congress with bills that let insurance companies sell policies across state lines or allow the government to use its purchasing power to negotiate lower drug prices.
Price noted in a letter to lawmakers that congressional rules don't allow the administration to include those ideas in the Obamacare replacement bill currently being considered. That's because Republicans plan to use a procedural tactic known as "reconciliation," which would allow them to push the bill through the Senate without the threat of a Democratic filibuster. There are strict limits on what a reconciliation measure can include.
"It's not able to be addressed specifically in this Phase One because it's not a revenue or spending issue for the federal government," Price told reporters.
He hopes to tackle interstate insurance sales and drug pricing in subsequent legislation, though that would require at least some support from Senate Democrats.