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Repeal and replace: 5 lawmakers shaping the future of the ACA

Health care reform is coming.

The only questions that remain are how, when, what, and who.

The replacement for the Affordable Care Act remains fuzzy, but Congress is taking definitive steps toward something new. While we can’t yet say what the law will look like, or when changes will come, we do have an increasingly clear picture of who will make it happen.

5 lawmakers shaping the future of the ACABy looking at who is actually going to repeal and replace the ACA, we can gather clues as to what that future holds. Here’s who has the most influence and what we can expect from them.

1. President Donald Trump

It may not be called “Trumpcare,” but the new law will definitely bear his mark.

Despite having little say over the language of the bill itself, Trump’s ideas will likely permeate new health care legislation. After all, he is the man who needs to sign it into law. Though those preferences have been vague, there are a few that stand out.

He favors health savings accounts (HSAs), and wants to expand them, from allowing annual rollovers to increasing the contribution limits. He’s also a fan of insurance marketplaces selling across state lines in an attempt to increase competition and drive prices down. He’s pushing for repeal and replace to happen simultaneously—and just a few weeks after he takes office. It’s an unlikely scenario, but one he’s likely to continue to stand behind.

Trump will have the final say if the bill becomes law, but expect more specific news to come from others around him.

2. Secretary of Health and Human Services Tom Price

Tom Price is a former doctor, current Congressman, and if he’s confirmed, the future Secretary of Health and Human Services. He has a strong understanding of the American health care system as both a doctor and as a politician, and has been one of the leading advocates for replacing the ACA.

While a Congressman, he created one of the most well-known replacements for the ACA: the Enabling Patients First Act. While his bill never became law, it’s likely that some of its language and ideas will help shape whatever replacement Congress does decide upon in the future—especially since Trump has said reform will begin once Price takes his post as Secretary of Health and Human Services.

His preferences are for removal of the individual mandate, tax credits instead of subsidies, aid based on age rather than income, and state-based, high-risk insurance pools.

Price won’t have any hand in drafting the bill or setting the timeline for repeal and replace. However, he will be responsible for enforcing certain aspects of the current and future health care laws, so it’s likely he will be lenient on enforcing the ACA until something new does pass.

3. Secretary of Labor Andrew Puzder

Andrew Puzder has been an outspoken critic of the ACA since it first passed. Although he disagrees with Trump on some issues, such as immigration, he agrees with the President-elect on his views about deregulation of businesses. As Secretary of Labor, Puzder would, like Price, be responsible for enforcing (or not) certain aspects of the current and future health care laws, as they apply to businesses.

He may also have a hand in shaping the policy, if not the bill itself. If this is the case, expect to see the definition of full time increase from 30 hours a week to 40, and the number of applicable large employers shrink.

4. Senator Bill Cassidy

Senator Cassidy of Louisiana has just been placed on two different Senate committees: the Committee on Finance and the Committee on Health, Education, Labor, and Pensions. Those roles indicate he may be taking the lead on some of the new health care issues due to pass through Congress. This is especially important considering the budget remediation vote that just went through, indicating that Congress needs to cut $1 billion from its health care budget.

He’s an avid supporter of a simultaneous repeal and replace, even if that means waiting to repeal. In the past, he’s proposed keeping large swaths of the ACA, and simply dropping the government mandates on individuals and employers, while giving more power to the states—something he introduced in “America’s Greatest Healthcare Plan,” the ACA replacement plan he sponsored last May.

5. Senator Rand Paul

Senator Rand Paul is also a former physician, and thus far has been an outspoken—often divergent—voice on health care. While he agrees with the rest of his party that the ACA should be repealed and replaced, he is adamant that those two should happen simultaneously. He was the only Republican to vote against the budget remediation on January 11, which allows politicians to start cutting pieces of the ACA that are government-funded.

He’s proposed his own health care plan in the past—one that aligns with Trump’s views on HSAs and breaking down state line barriers, but also proposes expanding associated health plans and allowing people to purchase insurance through non-traditional groups such as churches and civic associations.

Many pieces of a bigger machine

Of course, a majority in Congress is needed to pass whatever bill makes its way through the government and into law. Right now, the majority of Republicans seem to favor repeal now, replace, and less government influence overall.

While it’s not an entirely clear path, breadcrumbs point in some directions more than others. Most importantly, make sure to keep your reporting on track for this season—it’s unlikely, with this much indecisiveness, that something substantial will be passed that nullifies this year of reporting.