The “three phase” plan promise: Will Republicans vote yes?
With a House vote on the American Health Care Act (AHCA) looming, it’s unclear if Republicans have enough support to advance the bill, which many say doesn't do enough to adequately repeal and replace Obamacare. To garner support, Republicans are calling on their colleagues to look at the bigger picture: The AHCA is only the first step in a three-phase plan to reform American health care.
This three-phase plan has been alluded to and minimally discussed many times in recent weeks by the Trump administration, Republican leadership, and Health and Human Services Secretary Tom Price, and includes three steps: the passage of the American Health Care Act, the elimination and creation of regulations alongside additional Presidential executive orders, and the implementation of new legislation separate from the AHCA.
There’s been little detail revealed regarding phases two and three of the plan, however, begging the question: Is the mere promise of a more comprehensive plan enough to move the AHCA forward?
Here’s what we know.
Phase 1: The American Health Care Act
The details of phase one can be found in the pages of the AHCA. Contention over the bill within the Republican Party mounted after the Congressional Budget Office (CBO) reported how this law would impact the federal budget, the number of Americans insured, and the cost of insurance. While the CBO indicated that the overall federal deficit would decrease over the next 10 years, the number of uninsured Americans would rise, and in the short-term, premiums would rise as well.
These projections didn’t sit well with many conservative Republicans who believe the bill is being rushed and doesn’t do enough to improve health care for their constituents. In response, Republicans introduced amendments to key provisions of the law, and have begun emphasizing phases two and three of the overarching plan. In his CNN town hall, Tom Price went as far as to say that the CBO projections were inaccurate because they don’t take into account these subsequent phases of the plan.
Phase 2: The alteration, elimination and creation of regulations and executive orders
Neither President Trump nor the Republican Party have released many formal details about phase two of the plan, though it’s vaguely been referenced by some Republican leaders and Tom Price. In their words, the Department of Health and Human Services (HHS) is reviewing all current regulations and altering or eliminating those that burden the health care industry and Americans’ access to competitive, affordable health care plans.
They’ve also suggested that they would create new, “consumer-friendly” regulations in conjunction with executive orders from President Trump. No details on the substance of these regulations have been released yet, and no real implementation timelines have been laid out. Typically, creating new administrative regulations is a lengthy process conducted by the Department of HHS and subject to the rules of the Administrative Procedures Act (APA).
Republicans, Democrats, and the American people are eagerly awaiting more details.
Phase 3: New legislation
Surprisingly, more substantive details exist for phase three of the plan than phase two. Leaked versions of the AHCA included several provisions related to selling health care plans across state lines, the creation of association health plans for small businesses, and medical tort reform. These provisions are missing from the proposed version that exists today, partly because the AHCA is utilizing the reconciliation process, which limits what can be included in the bill.
However, these concepts have always been part of Republicans’ vision for health care, and Tom Price has confirmed these new pieces of legislation would ultimately be part of phase three. Again, much like phase two, there is no proposed timeline for this part of the plan.
At the very least, a skeleton of a three-phase plan exists at the Republican leadership level. How the details will unfold in real time is still unknown.
Will the promise of a larger plan that, in theory, would help fully realize the Republican dream for American health care be enough to keep phase one afloat? We’ll continue to monitor, and tune in tomorrow when the rubber meets the road during a House vote on the AHCA.