The Affordable Care Act was the hot topic at the Republicans retreat this past week. And while Senate and House Republicans were looking for more specificity and clarity from the Administration they didn’t get it when the President Trump spoke to them last Thursday.  Instead there were reports through the Washington Post and other publications that had access to some of the audios that there was a great deal of debate and uncertainty about how to proceed.  Debate included those expressing support for quick repeal while others expressed concern about going too fast and leaving people unprotected if Congress is not careful.

Last week also brought some of the first Republican legislation regarding the ACA. Senator Susan Collins (R-ME) and Senator Bill Cassidy (R-LA) introduced a joint bill, S 191 that would repeal the ACA.  The bill offers an array of three options one to keep the current law for states that choose but with reduced funding to 95 percent of what state is currently receiving if 95 percent of current recipients continue to receive coverage, a second option would repeal the insurance standards and take the money and provide it to the state to be passed on to people through health insurance savings accounts and the third option would simply allow a state to abandon the ACA including all the insurance minimum standards.  The legislation, if it were to move forward, would need a great more work in terms of formulas, implementation and other issues.

The Collins-Cassidy Bill is not an official Republican bill but is likely one of the many that may be introduced in the next several weeks. A few days after the introduction of their bill Senator Rand Paul (R-KY) introduce S 222.  His bill repeals all the insurance requirements enacted by the ACA and relies on some past proposals by allowing people to buy insurance across state lines regardless of their own state insurance standards, encourages the use of insurance pools, and provides tax credits and incentives including Health Savings Accounts and relieves states of some of the current Medicaid minimum requirements.

While this was taking place, the Administration created a controversy by Thursday when they pulled ads geared toward getting more people to sign up to the ACA in the closing days of open enrollment.  The ads had already been placed and were paid for but by Friday HHS seemed to backtrack when they started to get a strong blowback from some in the health community.

Within the short history of the ACA, the last days of open enrollment are some of the most important days because of the high numbers of people who have signed up in this time-period. More significantly these enrollees tend to be younger—the so-called “young invincibles” who are healthier and have the impact of making the insurance pool younger and healthier and thus drive down some the cost.  The concern is the pulling of the ads is an intentional effort to reduce the surge they have historically seen in the last few years of the law.

Advocates are trying to get the word out that you can still sign-up through January 31, and that there is free local assistance available.