Recovery Bulletin
March 6, 2017  | 

March 2017 Addiction Policy Update

Affordable Care Act Repeal & Replacement


While there continues to be much discussion in Washington about repealing and replacing the Affordable Care Act (ACA), the path forward for how to repeal, replace or possibly even “repair” the law remains unclear.

The new “repair” term entered the discussion in February and was used most significantly by Senator Orrin Hatch (R-UT); Hatch chairs the Senate Finance Committee, which plays a critical role in health policy.

The “repair” messaging could indicate that Republicans might not make wholesale changes to the nation’s health system as originally thought.


Republican leaders are trying to balance demands from more conservative Members that the law be immediately repealed versus concerns from more moderate members, especially those from states that expanded their Medicaid programs, about replacing the law without simultaneously replacing it. Demonstrating how strongly Americans can react to changes to health insurance – some Republican Members have recently been confronted at town hall meetings by constituents angry about possible repeal of the health reform law; these town hall meetings echo the Tea Party protests during consideration of the Affordable Care Act (ACA).

On February 16th, House leaders presented the attached policy brief to the Republican Caucus.  The 19-page plan does not go into a lot of detail and, as of press time, critical Congressional Budget Office numbers on cost and coverage are not yet publicly available.  Speaker Ryan (R-WI) has said Republicans plan to introduce a repeal and replace plan sometime after Congress returns from its President’s Day recess on February 27th.  It is unclear at this point if the Trump Administration will send its own detailed Affordable Care Act replacement plan to Capitol Hill for consideration.


There is pressure on policymakers to act quickly because insurers have told Congress & the Administration they need stability in the exchange marketplace. The timeline for them to act is short because insurers are making decisions about participation in the 2018 marketplace now.

In an effort to address some of the key concerns raised by insurers, on February 15th, the Administration released a rule with reforms it described as “critical” to stabilizing the exchange marketplace. Among other provisions, the rule attempts to address concerns from insurers that consumers may “game” the system by only purchasing insurance when they are sick by taking advantage of lax rules around special enrollment periods.


If finalized, the rule would:

  1. make it harder for patients to sign up outside of the annual enrollment period
  2. allow insurers to collect past-due premiums before starting coverage for a new year
  3. cut the length of the annual enrollment period in half – from 3 months to 45 days.


For More Details on the Rule: Timothy Jost Summary in Health Affairs
Why it Matters


The Affordable Care Act requires health plans in the individual/small group markets and Medicaid expansion benefit to cover addiction and mental health treatment and comply with the Mental Health Parity and Addiction Equity Act (MHPAEA).  Repeal of the law without an adequate replacement plan could eliminate these benefits and other consumer protections such as the prohibition on annual and lifetime caps and discrimination against individuals with pre-existing conditions.



This Policy Update was generously provided by Holly Strain & Carol McDaid of Capitol Decisions.