WEBVTT - Donald Trump Prepares Repeal and Replace For ACA  (Audio)

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<v Speaker 1>President Trump has called the Affordable Care Act a disaster

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<v Speaker 1>and has pledged to repeal it and replace it with

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<v Speaker 1>something better. One of President Trump's first official acts was

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<v Speaker 1>to sign an executive order commanding federal agencies were legally

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<v Speaker 1>possible to waive, delay, or defer parts of the law

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<v Speaker 1>that would burden states, individuals, or healthcare providers. It's not

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<v Speaker 1>clear what this order is going to mean in practice,

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<v Speaker 1>but on Sunday, Presidential advisor Kelly Anne Conway said that

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<v Speaker 1>the President may decide not to enforce the Affordable Care

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<v Speaker 1>Acts mandate that individuals purchase health insurance, and she also

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<v Speaker 1>seemed to suggest that the administration may refuse to enforce

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<v Speaker 1>the requirement that businesses with fifty or more employees provide

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<v Speaker 1>health insurance to their employees. Meanwhile, to Republican senators have

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<v Speaker 1>introduced a bill that they say would let states keep Obamacare,

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<v Speaker 1>abandon it, or replace it with a system of catastrophic

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<v Speaker 1>insurance for the uninsured. So what does this all mean?

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<v Speaker 1>Here today to talk with us about the future of

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<v Speaker 1>the Affordable Care acter ALDN. Bianchi, leader of the Employee

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<v Speaker 1>Benefits and Executive Compensation practice Group at mince Levin, who

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<v Speaker 1>is the author of the Bloomberg Bienna Healthcare Reform advisor,

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<v Speaker 1>and Abbey G. Look, Faculty director of the Solomon Center

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<v Speaker 1>for Health Law and Policy at Yale University. Abbey the

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<v Speaker 1>Presidents signed an executive order that many are confused by

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<v Speaker 1>UM and it's not really seemed to think, it's not

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<v Speaker 1>really clear about what he what he wants agencies to

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<v Speaker 1>do with the Affordable Care Act. And then his advisor Ms.

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<v Speaker 1>Conway goes on TV and says that he may not

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<v Speaker 1>enforce these mandates. Let's start with that. Can the administration

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<v Speaker 1>refused to enforce the two mandates to purchase insurance and

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<v Speaker 1>to have employers provide insurance if they have fifty or

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<v Speaker 1>more employees. Well, first of all, I think you're right

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<v Speaker 1>that this action has sort of injected more uncertain change

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<v Speaker 1>from already very uncertain business contacts for insurers because nobody

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<v Speaker 1>really knows what's going to happen. The executive order makes

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<v Speaker 1>very clear that the agencies can only act to the

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<v Speaker 1>extent authorized by law UM With respect to the individual mandate,

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<v Speaker 1>the requirement that everybody has to get themselves insured or

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<v Speaker 1>pay attacks a very very controversial requirement under the Affordable

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<v Speaker 1>Care Act, UM. As a legal matter, it's very unlikely

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<v Speaker 1>that the Trump administration could use that executive order the

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<v Speaker 1>wholesale abandoned the individual mandate. That would not be permitted

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<v Speaker 1>consistent with the law as the executive order requires. They

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<v Speaker 1>could extend some of the hardship exemptions that were offered

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<v Speaker 1>by the Obama administration, but the exception can swallow the rule.

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<v Speaker 1>So the Trump is serious about obeying the law, and

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<v Speaker 1>that you think is not consistently um. I don't think

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<v Speaker 1>that what Kelly and Conway said is likely to hold forth.

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<v Speaker 1>I also just know that Tom Price, the HHS nominee,

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<v Speaker 1>and his confirmation hearing, also alluded to the idea that

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<v Speaker 1>they were not going to use that executive order, uh,

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<v Speaker 1>the wholesale stop enforcing the individual mandate. All. Then, what

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<v Speaker 1>do you make of Tom Price's testimony where Trump's choice

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<v Speaker 1>for Health Secretary repeatedly refused used during the confirmation hearing

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<v Speaker 1>to promise that no Americans will be worse off under

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<v Speaker 1>Trump's executive order to ease provisions of the Affordable Care Act. Well,

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<v Speaker 1>one thing I begin by noting is is that I

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<v Speaker 1>think Tom Price was not at all bloodied during yesterday's

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<v Speaker 1>confirmation hearing. So if Democrats thought that they were going

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<v Speaker 1>to somehow derail that domination, I think the hopes of

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<v Speaker 1>that are fading very quickly. Then the question is is

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<v Speaker 1>how does the how does replace go forward? And I

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<v Speaker 1>think Representative Price has been been very cryptic in any numbers.

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<v Speaker 1>We have no idea or very little idea from his

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<v Speaker 1>from his his public statements and testimony, exactly what he's

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<v Speaker 1>going to do. But we do have a comprehensive bill

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<v Speaker 1>that he had two comprehensive bills, one a pure repeal

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<v Speaker 1>bill on the reconciliation and the other repeal and replace

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<v Speaker 1>that Tom that Tom Price either offered authored or as

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<v Speaker 1>a co author, so we has we have his policy prescriptions,

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<v Speaker 1>so we know I think we know what he wants

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<v Speaker 1>to do and and and those prescriptions are very similar

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<v Speaker 1>to the prescriptions in in five other major Republican proposals,

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<v Speaker 1>So I think he's uh, we we we pretty much

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<v Speaker 1>know where he's going to go. You're listening to Bloomberg

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<v Speaker 1>Law with Michael Best, June Grosso, and Greg Store and

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<v Speaker 1>we are talking about the Affordable Care Act. The President's

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<v Speaker 1>actions and statements have not yet repealed the law, and

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<v Speaker 1>neither has Congress. UH. He's talking about it today, He's

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<v Speaker 1>been talking about it since he took office, But it's

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<v Speaker 1>not entirely clear what is going to happen to what

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<v Speaker 1>is known as Obamacare. Talking to us about the future

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<v Speaker 1>of the health care law are Alden Bianchi, a member

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<v Speaker 1>at mince Levin UH, and Abby glucka professor at Yale

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<v Speaker 1>Law School. Abbey the President's executive Order, as you noted earlier,

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<v Speaker 1>only allows agencies to do to take actions that are

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<v Speaker 1>within the current law. But what has to the extent

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<v Speaker 1>we can figure it out, what has the President ordered

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<v Speaker 1>agencies to do in regard to the Affordable Care Act? Well?

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<v Speaker 1>Nothing yet. I mean, that's that's what's caused all this uncertainty.

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<v Speaker 1>There's been a lot of talk, and you also have

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<v Speaker 1>Trump throughout making statements like every American who currently has

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<v Speaker 1>health insurance is going to keep their health insurance or

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<v Speaker 1>get health insurance. Um. And yet you've got these Republican

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<v Speaker 1>plans voting around that don't all do that? Right? And

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<v Speaker 1>we've had now eight years of Republicans trying to come

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<v Speaker 1>up with the consensus agreement on what their replacement plan

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<v Speaker 1>would be. We shouldn't be surprised that two weeks into

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<v Speaker 1>the new administration they don't have their plan yet. They

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<v Speaker 1>haven't had one for eight years for getting sort of

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<v Speaker 1>different plans every day. I don't think anybody knows what's

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<v Speaker 1>going on except the one thing I think that I

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<v Speaker 1>think the administration and the Senate have heard the business

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<v Speaker 1>community's complaints about the idea of repealing without having a replacement,

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<v Speaker 1>or at least a partial replacement up in the wings.

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<v Speaker 1>Early on, it looked like they were going to get

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<v Speaker 1>repealed with nothing. Looking now like um, there are at

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<v Speaker 1>least some people in there who are really trying to

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<v Speaker 1>have something to say before they get to repeal, and

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<v Speaker 1>that would may make repeal take a lot longer, frankly,

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<v Speaker 1>um than Trump would have wanted. All Republican Senators Susan

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<v Speaker 1>Collins and Bill Cassidy, unveiled in Obamacare replacement bill this week,

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<v Speaker 1>tell us about some of the proposals that are out there. Well,

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<v Speaker 1>if you look at that, there are probably give or

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<v Speaker 1>take five key Republican proposals, and they do share an

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<v Speaker 1>awful lot of common features. So if we could tick

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<v Speaker 1>down the major ones pretty quickly rather than an individual mandate,

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<v Speaker 1>that would be something called a continuous coverage requirement. This

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<v Speaker 1>has been around since with HIPPA, and it has worked

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<v Speaker 1>very well in the group market, and it should work

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<v Speaker 1>fine so long as people are generally employed. I think

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<v Speaker 1>the problem with it comes where people are in and

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<v Speaker 1>out of employment on routinely and they're at that feature

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<v Speaker 1>not work so well. There's also the issue of of

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<v Speaker 1>tax subsidies for employees, and they're both the replacement proposals

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<v Speaker 1>in Obamacare have tax subsidies for low income folks to

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<v Speaker 1>help purchase coverage, but what they do is very different.

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<v Speaker 1>So in Obamacare, those subsidies are are applied to the

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<v Speaker 1>metallic tears of coverage goal bronze, silver, goal platinum, which

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<v Speaker 1>are very very prescribed arrangements, whereas under the Republican proposals,

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<v Speaker 1>it's it's kind of the wild West. You can purchase

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<v Speaker 1>coverage across state lines, and perhaps and and and the

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<v Speaker 1>design of these policies would they'll be huge variations in

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<v Speaker 1>what they cover or don't cover. Importantly, and lastly, in

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<v Speaker 1>regard to the individual mandate, there's a provision in most

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<v Speaker 1>of these proposals that says, um, if you can't get coverage,

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<v Speaker 1>then we're going to revert to the state high risk polls.

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<v Speaker 1>I don't have time really here to go through all

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<v Speaker 1>of them. But one other feature I'll mention that is,

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<v Speaker 1>UM sounds like a good idea, but it has been

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<v Speaker 1>problematic in the past in terms of enforcement. And that's

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<v Speaker 1>the idea of small groups banning together to form association

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<v Speaker 1>health plans. Uh. These have been abused commercially for the

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<v Speaker 1>last twenty years, so enforcement would be the big deal here.

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<v Speaker 1>They would also cannibalize the state small group markets. So

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<v Speaker 1>those are a flavor of some of the proposals that

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<v Speaker 1>are common to all of the five five Republican proposals. ABBY.

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<v Speaker 1>There there is a relatively new proposal from Senators Cassidy

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<v Speaker 1>and Collins that seems to depart from some of the

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<v Speaker 1>previous Republican proposals and that it would allow states if

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<v Speaker 1>they want to to keep Obamacare in place. What what

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<v Speaker 1>is their proposal? Yeah, it's an interesting, uh sort of

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<v Speaker 1>compromise proposal. UM. It won't make some people happy because

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<v Speaker 1>it's not actually repealing Obamacare. But what it does is

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<v Speaker 1>it gives the states three options. UM. You might call

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<v Speaker 1>it a federalist proposal. One that's about state choice. Option

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<v Speaker 1>one is you get to keep obama Care the way

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<v Speaker 1>you have it if your state is happy with how

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<v Speaker 1>it's functioning. That would probably happen, say in New York,

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<v Speaker 1>for example. Option two is that you get to just

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<v Speaker 1>be done with Obamacare. You get to stop receiving funds

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<v Speaker 1>and you're out of the system and the state funds

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<v Speaker 1>for it self as if Obamacare never been enacted. And

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<v Speaker 1>a third option is this idea of sort of state innovation,

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<v Speaker 1>state choice. The state would be able to get I

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<v Speaker 1>think it's of the money they would otherwise be getting

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<v Speaker 1>under the Affordable Care Act, and they get to use

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<v Speaker 1>that to put it into a state designed healthcare system

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<v Speaker 1>of their choice. Right, so it's almost like a waiver.

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<v Speaker 1>You might think of it as a souped up waiver

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<v Speaker 1>from Obamacare, which we already had this wavor provision and

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<v Speaker 1>the original Affordable Care Act, and you might think of

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<v Speaker 1>this is sort of cheering off of that. It does

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<v Speaker 1>get rid of the individual mandate because that is the

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<v Speaker 1>least popular, uh, the least popular provision, and it would

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<v Speaker 1>adopt this continuous coverage requirement that all them just talked

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<v Speaker 1>about all the is this uncertainty about the Affordable Care

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<v Speaker 1>Act having any effect on the insurance marketplace right now,

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<v Speaker 1>it is too early to tell that for certain, but

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<v Speaker 1>there has to be some uncertainty underneath the hood that

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<v Speaker 1>hasn't bubbled to the surface yet. It just would be

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<v Speaker 1>inconceivable to me that the carriers, in particular, we've got

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<v Speaker 1>to be scratching their head saying where's our revenue coming from?

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<v Speaker 1>And the individuals that are covered, or saying is my

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<v Speaker 1>coverage even going to be there? Coincidentally, I just I

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<v Speaker 1>had a call last night just from one of my

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<v Speaker 1>my partners who has a young son who is going

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<v Speaker 1>to age out of the hit aged and has would

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<v Speaker 1>have some real pre existing condition concerns, And this question

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<v Speaker 1>to me, is my kid going to be all right?

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<v Speaker 1>So yeah, I mean there has to be, although I

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<v Speaker 1>can't I can't point you to to particular evidence at

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<v Speaker 1>this point, Abby. One of the issues that seems to

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<v Speaker 1>have slowed down the trained to repeal Obamacare was that

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<v Speaker 1>any replacement plan probably would have to survive a Democratic

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<v Speaker 1>filibuster in the Senate, meaning it would need sixty votes

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<v Speaker 1>in order to go forward, and that's going to be

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<v Speaker 1>very difficult for the Republicans to pull off. It seems

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<v Speaker 1>do any of the Republican plans that we've been talking about,

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<v Speaker 1>this replacement plan that the two senators have come up with,

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<v Speaker 1>do any of them have any chance of getting to

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<v Speaker 1>a point where Democrats might start supporting them. So I

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<v Speaker 1>haven't seen democratic leadership commentary on Cassidy Collins, but I

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<v Speaker 1>do think that just based on its one day of

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<v Speaker 1>life existence so far, that's probably the one that has

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<v Speaker 1>the greatest possible chance, particularly if it were strengthened and

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<v Speaker 1>in certain areas. I mean, it preserves things that Democrats

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<v Speaker 1>care about. It preserves a Medicaid expansion, which is very important.

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<v Speaker 1>It doesn't aim to privatize Medicare like the Paul ryan

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<v Speaker 1>Ran plan would. I could see maybe having the individual

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<v Speaker 1>mandate remain optional, um and that would probably help these concerns.

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<v Speaker 1>I think there is concern among progressives that the continuous

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<v Speaker 1>coverage requirement would be punitive against people UH with less

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<v Speaker 1>steady employment employment, which tends to be people that are

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<v Speaker 1>falling in the gap between Medicaid and the private insurance market,

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<v Speaker 1>the less fortunate um And so I could see that

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<v Speaker 1>being a starting point, UM. But we really have the

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<v Speaker 1>act to see UM. How the Democrats are going to

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<v Speaker 1>react to it. And I also think that Strucumer has

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<v Speaker 1>been very clear that he doesn't want to help Trump

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<v Speaker 1>out of this problem. Right. Um, they've created this uncertainty,

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<v Speaker 1>that sort of created this mess, and I think the

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<v Speaker 1>Democrats wanted to say, you know, we're not going to

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<v Speaker 1>take the blame by helping you enact a subpar replacement

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<v Speaker 1>for the Affordable Care Act. So that's a challenge. All

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<v Speaker 1>then we have about thirty seconds left. Do you think

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<v Speaker 1>the Republicans can come up with something that will they'll

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<v Speaker 1>be able to replace Obamacare with anytime in the near future.

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<v Speaker 1>I think they do, and I think if you want

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<v Speaker 1>to know what that's going to look like, probably the

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<v Speaker 1>most thoughtful proposal is the one that was put forward

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<v Speaker 1>by Range Hatch. Now it's not a it's not legislation yet,

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<v Speaker 1>say it's a five or six or seven page set

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<v Speaker 1>of bullet points, but it is and I think it's

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<v Speaker 1>been been reviewed fairly favorably. Um, whether it will do

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<v Speaker 1>what I doubt very seriously do what the Affordable Care

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<v Speaker 1>Act did, but it's pretty good. And lastly, i'd point

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<v Speaker 1>out that that people have seemed to have forgotten very

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<v Speaker 1>quickly that the Affordable Care Act was really a Republican proposal.

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<v Speaker 1>It was, it was done by a Republican governor, Mitt Romney,

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<v Speaker 1>and it was designed by the Heritage in large part

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<v Speaker 1>by the Heritage Foundation. So it just shows you how

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<v Speaker 1>far we've we've we've gone from our moorings on this

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<v Speaker 1>on this topic, well, I suspect we also won't stop

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<v Speaker 1>talking about it for some time to come. Thank you

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<v Speaker 1>to Aldon Bianchi of mince Levin and Abbey Gluck of

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<v Speaker 1>Yeah Law School for being with us today on Bloomberg

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<v Speaker 1>Law