ALEC Statement of Principles on Repealing and Replacing the Affordable Care Act (ACA)

ALEC Statement of Principles on Repealing and Replacing the Affordable Care Act (ACA)

ALEC Statement of Principles on

Repealing and Replacing the Affordable Care Act (ACA)


Mission: To promote access, affordable health benefits, greater competition and choice, health savings, responsibility and incentives for a healthcare system that supports continuous coverage for all Americans.

The Affordable Care Act (ACA) is collapsing. If Congress and the Executive Branch do not repeal harmful taxes, fees and regulatory mandates, Americans will continue to lose access to health coverage and see double-digit increases in their health insurance premiums. As it stands now, one-third of the counties across the United States only have access to a single insurance carrier.

We have a once-in-a-generation opportunity to reform the U.S. healthcare system. The increased taxes, penalties, mandates that was brought on by the Affordable Care Act has driven up premiums and reduced access to affordable health coverage since it was signed into law in 2010.

Through a combination of deregulation and waiving requirements through rule-making at the U.S. Department of Health and Human Services and federal legislative action, ALEC supports enacting public policies that will create a patient-centered healthcare system that grants maximum authority to states in how they regulate their insurance markets, provide truly affordable healthcare, as well as reform each state’s Medicaid program.


Repeal all taxes, fees and mandates in the Affordable Care Act.

The roughly one trillion dollars in new or higher taxes imposed by the ACA directly hit middle class families and small businesses, raise the cost of healthcare, and reduce access to care and should be repealed as expeditiously as possible.


Give states the authority to opt-out of harmful ACA provisions that reduce access and increase the cost of care.

If the ACA is not fully repealed, ensure states have the authority to opt-out of harmful provisions of the law, such as the mandatory essential health benefits, guaranteed issue; mandated preventive health services and age rating bands. And further, give states the statutory authority to freeze enrollment for the able-bodied population of the Medicaid program.


Give states maximum flexibility in designing and implementing innovative reforms to their Medicaid programs.

Allow states the authority to become “laboratories of democracy” in the design and implementation of their Medicaid programs. Once the federal core requirements and required health outcomes of Medicaid have been met, states should have the authority to implement cost-saving and care-improving reforms without having received explicit federal approval for each reform. Some examples of program



reforms include increasing the availability and use of telemedicine, using lower cost options for transportation and incentivizing the use of community based resources to keep beneficiaries in their homes as long as possible.


Repeal Medicaid Expansion.

Discourage dependency on taxpayer funded entitlement programs by focusing on market-based policies that will bring down the cost of healthcare and health insurance for hard working Americans. Allowing able-bodied adults to qualify for the Medicaid program crowd’s out other state funding priorities like building schools, hiring teachers, fixing roads, supporting law enforcement, and relieving struggling businesses and families of high tax burdens discourages work and weakens the safety net for our most vulnerable populations.

Repeal the enhanced match rate for the Medicaid expansion population.

Preserve Medicaid for the truly vulnerable and eliminate the enhanced federal match rate for able-bodied, childless adults under the Medicaid Expansion provision of the Affordable Care Act.


Allow states to choose to opt-in to either a per-capita allotment or block grant reimbursement system for Medicaid.

Under a per-capita allotment or block grant reimbursement structure, states will be granted greater flexibility to manage the program with less federal interference, as well as provide increased budget predictability and control over Medicaid expenditures. And further, the Congressional Budget Office has projected enrollment declines by the Center for Medicare and Medicaid Services’ projected per capita Medicaid spending would result in an estimated $768.2 billion in federal savings between 2018 and 2026.


Return states’ authority to regulate their health insurance markets.

Allow states the ability to waive the Title One provisions of the ACA and opt-out of costly and harmful mandated health benefits.


Market stabilization funds and protections for Individuals with pre-existing conditions.

Americans fear losing their health insurance or ability to obtain or serious financial hardship if they develop a serious health problem. A state-run high risk pool or safety net program is designed to lower patient costs and stabilize state insurance markets. When in place, this will reduce the cost of providing health insurance coverage in the individual and small group markets as defined by the state, to individuals who have or are projected to have a high rate of utilization of healthcare.


Allow the use of federal tax credits for working Americans and the elderly to purchase health insurance.

Currently, only employers are allowed to purchase health insurance with pre-tax dollars. This is not only unfair to individuals, the self-employed, and their families, but it also fosters a dependence on employer provided health care. With tax credits, individuals would be encouraged to shop around for the best plan to meet their needs. Purchasers would become more sensitive to the price and utilization of insurance and, in effect, would spur stronger competition within the health care industry, helping to keep costs under control.


Encourage the use of and remove barriers to Health Savings Accounts (HSAs) and Healthcare Sharing for individuals and families.

HSAs provide a tax-preferred vehicle for families to set aside resources to pay for expenses not covered by insurance and individuals and families should have the option to couple with insurance to provide financial protection for major expenses. A health care sharing ministry or otherwise affiliated group is an organization that facilitates sharing of health care costs among individual members, and should be encouraged as a free-market alternative for access to healthcare in the U.S.


Regulations as a last resort.

When other solutions are not possible, due to the impracticality of defining rights or harnessing markets, simple and straightforward regulation can be an effective last resort. Regulation should always be simple and transparent, focusing on the particular issue and should not become an opportunity to provide favoritism to particular special interests.