“You really do have to have 60 votes to replace and you know reconciliation can create some hangover effects as we’ve seen with the health care bill itself and with the Bush tax cuts and all of that so are you better off going ahead and attempting to put something in place that will work that does away with all the negatives that exist in ACA, but builds on some of the positives?” Corker asked. “Again, President-elect Trump mentioned, I thought wisely during the campaign, that replacement and repeal should be done simultaneously.”
The negatives (mandates, reinsurance, risk adjustment, risk corridors) and the annoying (narrow networks, HMO’s, high cost sharing) were needed to make the popular stuff work (guarantee issue, community rating) work. Definitions as to what counted as a qualified plan were needed. Definitions as to what counts as an essential health benefit were needed. All of the negatives were needed . They can be tweaked and twisted. The continual enrollment concept changes the form of a mandate but performs the same function of making going without coverage too expensive to be attractive. The negative stuff was not put into the bill for shits and giggles.
About the only major things in the medical coverage expansion sections of the ACA that don’t need the negatives of the ACA are Medicaid expansion and the Under-26 coverage expansions. Those are easy things that are severable from the core of the three legged stool. One is state by state single payer and the other is an expansion of multi-payer community rated/guaranteed issue coverage.
We’ll see this refrain at least four times a week for the next four years. Health policy is hard even if the objective is to present a patina of coverage in order to loot. Actually providing a usable coverage expansion is harder.
Update 1: Victor in comments makes a very good point:
I think it is also fair to point out that most of the stuff on the revenue side was also unnecessary. The ACA can work without the employer mandate or the cadillac tax although the Cadillac tax is a good economic policy. The employer mandate was a fine rule from a fairness issue but can easily cause labor market distortions.