Jan 25, 2017

Grassley on where things stand with Obamacare

Cliff Owen / AP

Sen. Chuck Grassley, a senior member of the Finance Committee, talked to me recently about the wonkier sides of Obamacare repeal and replace.

While there are things Republicans agree on — no mandates, health savings accounts, refundable tax credits — there are also plenty of areas up for debate, such as whether to help pay for a replacement with taxes. Grassley thinks it will need new taxes. He's also not convinced that the GOP needs to have the replacement ready when the law is repealed.

And Grassley predicts the eventual GOP health plan will cover as many people as Obamacare, but won't guarantee it will lower their deductibles. Read on for the highlights.

On Obamacare and what the repeal bill, passed through a process known as reconciliation, might look like:

The model is going to be based on the reconciliation bill Congress passed last year, which President Barack Obama vetoed. "At least there and maybe something a little less, but that something has not been defined yet."

Something a little bit less?

"Well, I don't know whether there's 50 items or 25 items. Whatever's in that thing, there won't be more than that. It's stuck in reconciliation."

Do you have qualms about repealing Obamacare without a replacement?

"All I can say is it would be better if we had replacement the same time as a repeal, but if you waited to get a consensus on replacement, then we wouldn't be seen as keeping our promise that very early, we're going to repeal. So the politics, or let's say the expectations as a result of the election, almost force you to do it in two separate moves."

Areas where Republicans generally have consensus on Obamacare replacement:

No employer mandate, no individual mandate, use of health savings accounts, selling insurance across state lanes, refundable tax credits, covering pre-existing conditions (either by making sure companies offer coverage to the sick, or having a "robust" high risk pool).

Is there agreement on the size of the tax credit?

Not yet.

How would you pay for a replacement? Republicans have talked about how much they don't like Obamacare taxes.

"That's an issue that's still not settled as far as the repeal is concerned, because there's some of the Republicans on the Finance Committee are arguing that if you repeal all these taxes, you're going to be praised for repealing, but then down the road when you have replacement, if you have to raise other taxes to pay for it, then all of a sudden you become a tax increaser."

Is there any way to do a replacement without new taxes?

"No, I don't think so."

On putting some pieces of Obamacare replacement in a tax reform package:

It could happen, because "it kind of gets around the business of increasing taxes."

How so?

"[If] we decreased taxes in repeal and then down the road six months, when your replacement if you need money, you're going to be a tax increaser. But if you got tax revision and replacement at the same time in the same package, it's kind of hidden."

Is universal coverage a goal of replacement?

"There wasn't even agreement on that under Obamacare, because there's 29 million people don't have health insurance. So I guess you'd say neither party has a goal of universal coverage."

Do you think the Republican plan could take care of as many as 20 million people, who were uninsured before 2010?

"Yes, but it's not going to be done through a mandate." He also takes issue with the 20 million estimate for Obamacare coverage.

If you want to have that many people covered, you also want it to cost less. How do you do that without having skimpier plans?

"Our goal is to let the marketplace make that decision. As opposed to the government ... Obamacare has really not given people health insurance because so many people have such high deductibles that for most of their health care, unless they've got major medical, have to pay out of their own pocket."

Can you guarantee that under the Republican plan, middle class people will have lower deductibles?

"I'm going to guarantee them they're going to have more choice. Because the government's not going to dictate the health insurance policies."

On Medicare:

"Medicare isn't going to be involved in this at all."

And on offering stability to insurers:

"I do think we do have to be concerned ... that there's some certainty for the private health insurers."

Do you think Congress is obligated to give them certainty? Particularly financially?

"Haven't had enough discussion on that yet ... The middle ground's gotta be found within the Republican party."

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