MONTPELIER — Congressman Peter Welch told Vermont lawmakers Wednesday that he is working to thwart Republicans from completely unraveling the Affordable Care Act, an action he said would be “one of the most reckless fiscal actions.”
Welch, a Democrat and the state’s lone member of the U.S. House, will begin serving under his third president Friday when Republican President-elect Donald Trump is sworn into office. He was first elected in 2006, and served two years under President George W. Bush and eight years under President Barack Obama.
During Obama’s tenure, House Republicans voted 65 times to repeal the federal Affordable Care Act, a landmark health care reform bill Obama signed into law. Now, with a Republican Congress and an incoming Republican Congress, Welch warned Wednesday that major changes are coming that could be disruptive to Vermonters and all Americans.
“It’s as though the discussion is ideological, that getting rid of this will give people more freedom,” he told lawmakers. “They’re deadly serious. Those who have been voting 65 times to repeal this bill want to do it.”
In fact, both the Republican led House and Senate have already taken initial votes to begin the law’s unraveling. Initial votes will allow Republicans to repeal portions of the law related to the budget without needing a 60-vote majority in the Senate. Rather, a simple majority, which Senate Republicans have, will suffice.
Welch said Republicans will be able to repeal Medicaid subsidies in the law that have allowed states to expand the program. They will also be able to repeal revenue sources that have helped to cover the cost of the law, including a tax on high-level insurance plans and medical devices.
“A lot of these taxes are controversial in their own right … but if you take those away and you don’t substitute anything you’re going to have this huge addition to the deficit,” Welch said.
Additionally, the individual mandate requiring the purchase of health insurance could be repealed, which along with the loss of revenue, would cause the insurance system to collapse.
“How do you make the pool large enough to accommodate people with pre-existing conditions and chronic illness?” the congressman said.
Republicans have spoken favorably of turning Medicaid funding into block grants to each state, which would allow states to determine how best to use the money. But Welch said any block grant system is likely to result in significantly less federal funding for the program, leaving Vermont and other states with gaping holes in their budgets.
“If those subsidies go away then it’s going to hurt your bottom line,” he said.
Some popular parts of ACA cannot be repealed by Republicans through the budget process, including the elimination of lifetime limits on insurance benefits, declining coverage due to pre-existing conditions and allowing young adults to remain on their parents’ coverage through age 26.
“More people talk to me about that because we’re all so anxious about our kids when they’re getting out of high school or they’re getting out of college,” Welch said.
Welch warned that Republicans are moving forward with a repeal of ACA before explaining to Americans what will replace it.
“It’s real, is what I’m saying. There is not a replacement plan. That’s the thing that is really quite astonishing,” he said. “Once you put pen to paper and you get off the abstractions of, ‘This is a government takeover,’ … then you get into the very hard legislative work of hard choices. How are we going to pay for it? What’s the benefit level going to be. How does this effect our community hospitals?”
However, he said those concerns are “being waved away as though the repeal provides a self-executing replacement.”
Welch said he does not expect Congress to make any significant changes to Medicaid before the Vermont Legislature adjourns for the year, likely in May. Senate President Pro Tem Tim Ashe, D-Chittenden, told reporters Wednesday that it’s possible lawmakers will need to return for a special legislative session to revise the state budget if federal policy impacts funding for the 2018 fiscal year.
“There will be some short-term implications for us as a result of Congressional action. We might know some of that while we’re here. The big picture changes to Medicaid are ones that I think we will likely not know by the time we get out of here in May,” Ashe said. “I have said that we should have in the back of our mind the likelihood … that maybe we will have to come back this fall to revise our budget.”
Ashe said he has advised fellow senators that some difficult decisions may need to be made in the next several months.
“It’s more than frustrating. It’s almost a crippling uncertainty at the federal level,” Ashe said. “There are things we may know while we’re here. For instance, Planned Parenthood funding could quickly be on the chopping block. That would lead the Legislature to have to make decisions about whether to backfill for some of those preventive services provided by Planned Parenthood.”
Meanwhile, Welch said he hopes to work with Trump administration on a large-scale infrastructure plan that will help improve roadways and deliver broadband access to more people.
Senate President Pro Tem Tim Ashe, D-Chittenden, along with the leadership of the Senate Health and Welfare Committee, presented Welch with a letter asking for him to continue pushing for the federal government to negotiate prescription drug prices for federal health care programs.
Welch noted that Trump has indicated he wants to force drugmakers to negotiate lower prices.
“We’ve got Trump with us on this — I mean, we think,” Welch said.