Safe For The Moment But...

The Senate's Repeal efforts in July 2017 were unsuccessful. All three plans, from repeal and replace to the skinny repeal, failed to gain the necessary votes to pass. Senators Collins (R-ME) and Murkowski (R-AK) were joined by Senator McCain (R-AZ) on the final vote that ended the Republicans' partisan attempts to end the ACA.

Many in Congress are committed to bipartisan solutions to the instability in the ACA marketplaces and on the individual markets, and negotiations are underway. The Republican leadership has expressed other legislative priorities for the remainder of the year.

However, the President, Senator Cassidy and the Freedom Caucus remain committed to repealing the ACA. Trump continues to threaten to withhold cost sharing reduction (CSR) payments to insurers. Without a firm commitment to CSRs and uncertainty regarding the individual mandate, insurers continue to withdraw from markets and premiums for 2018 are skyrocketing. Most individuals will be shielded from the full force of the increased premiums as they receive subsidies. Not so for middle and upper middle class Americans, who will be paying substantially more in 2018 for the same level of coverage as in 2018. Click here for KFF article.

A large majority of Americans (78%) think the President and his administration should make the current health law work. A majority (60%) want bipartisan solutions to improve it. click here for KFF poll.


The Convoluted Path to Repeal and/or Replace

Vox has a very helpful flowchart explaining the many steps to get to Repeal and/or Replace. Click here. Basically, McConnell needs only 50 Senators to vote for his bill because VP Pence will cast the necessary vote to get them to 51. During the vote-a-rama, amendments can be added to the bill, but McConnell still has the authority to disregard all amendments in the final moments. The best outcome is to defeat the motion to proceed at the outset. 

Proposed Senate Repeal and Replacement for the ACA

Mitch McConnell is determined to push the Republicans' Repeal and Replace bill for a vote next week, by July 21. He needs only 50 Senators to close the deal, because VP Pence will step in to cast the deciding vote to pass it. 

The BRCA, as they have named the bill, dramatically changes the ACA. The CBO estimates that 22 million Americans will lose their coverage in the coming years. Here are four main changes:

1. The individual mandate would be abolished under the Senate plan. Without a requirement to buy a policy, many healthy people will go without coverage or buy a new bare bones policy. That means prices will sky rocket for anyone who wants to buy a policy that covers the 10 essential benefits of the ACA. Insurers would prefer that everyone bought a policy, and have advocated for raising the penalty for not purchasing a policy because it wasn't high enough to compel people.

2. Older Americans on the individual market will see enormous premium increases. Currently, insurers are only allowed to charge those aged 50-64 3 times the premium of younger Americans. The BRCA will increase that from 3 to 5 times the premium. If a 20 year old pays $300/month for a platinum plan (current price in LA), an older American would pay up to $1,575/month. That would be $18,900 premium for an individual, $37,800 for a couple - until they qualify for Medicare. 

3. Pre-existing conditions would be undermined indirectly, but with devastating consequences. States would be allowed to seek waivers for insurance companies to offer bare bones policies, as long as at least one plan is offered that would cover the essential benefits in the ACA. Many healthy people would go with the cheap, minimal policies, making the market for the essential benefits policy incredibly expensive. 

4. Medicaid funding will be dramatically altered to limit its growth in many ways. (1) It would eliminate enhanced funding for Medicaid expansion by 2021 (2 months after the 2020 election - what a convenient coincidence). (2) Then federal spending would decrease each of the following 3 years. (3) Finally, there would be overall limits to eligibility that would affect the 70 million American children, disabled, elderly and poor who receive benefits. States would not be able to absorb the steep cuts, so there would be draconian cuts to enrollment qualifications, benefits and provider rates. 

House Republican's Repeal/Replace Bill Withdrawn

Ryan has withdrawn the Republican's first ACA Repeal and Replace bill due to lack of support. This action happened on the 7th anniversary of the ACA - March 23. Despite pledging to repeal and replace the ACA for 7 years, now that Republicans have control of the Congress and the presidency, they have been unable to craft a successful bill. It is unclear what steps Republicans will take on healthcare next, but the individual and exchange markets are seeking reassurances regarding funding from the administration.