Though the measure may be shelved for now, the fate of federal ACA subsidies remains uncertain.
An effort in the Senate to repeal and replace the Affordable Care Act (ACA) failed to garner enough votes for passage as four Republican Senators announced they would not support the bill. Yet even before Senators Jerry Moran of Kansas and Mike Lee of Utah joined Rand Paul of Kentucky and Susan Collins of Maine in opposing the Better Care Reconciliation Act (BCRA), the Senate version was in jeopardy due to Sen. John McCain’s absence following surgery.
In response, Senate Majority Leader Mitch McConnell said he would submit a measure repealing the ACA outright “in the near future,” but delaying implementation of a replacement plan for two years. Several GOP Senators, however, said they would not support such an option. “There’s enough chaos and uncertainty already and this would just contribute to it,” Alaska Senator Lisa Murkowski told Bloomberg. Collins and Shelley Moore Capito of West Virginia also voiced their intention to vote against a repeal-only bill, casting doubt on whether that legislation could ultimately pass.
Will Cost-Sharing Subsidies Survive?
With BCRA apparently shelved for now, uncertainty surrounds one aspect of the ACA: the federal subsidies helping low-income enrollees pay for deductibles and copays. While President Trump in a Twitter post supported a repeal followed by a replacement, his administration has previously given mixed signals on the fate of the subsidies that are given to insurers.
In April, President Trump said he was considering withholding those payments as a way to engage Democrats in the healthcare reform process. Nevertheless, his preliminary budget included increased funding for the ACA’s cost-sharing subsidies. Likewise, the Senate package, as did the previous House version, set aside funds to shore up the ACA’s individual marketplace.
Comments from White House Press Secretary Sean Spicer in Bloomberg indicated President Trump remains undecided on whether to cut off the subsidies. “Of course it’s always an option,” Spicer said Tuesday (July 18). “We have a couple days left.” The deadline for making the next monthly payment is Thursday (July 20).
Health insurers countered eliminating the subsidies would deepen the confusion currently swirling in the individual marketplace and possibly hasten more providers to exit the ACA exchanges or raise rates. “Our members and all Americans need the certainty and security of knowing coverage will be available and affordable for them,” Justine Handelman, SVP of Policy and Representation for the Blue Cross Blue Shield Association, told Bloomberg.
If the administration suspends the cost-sharing reduction (CSR) payments, the Kaiser Family Foundation estimates silver plan (the plan level at which subsidies are available) premiums would rise an average of 19%. But the foundation added its calculations assume “insurers would be willing to stay in the market if CSR payments are eliminated.”
A Bipartisan Solution
After the latest setback for healthcare reform, lawmakers from both parties suggested a bipartisan solution may be next step. Most prominent among those voices was Senator McCain. “The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care,” McCain said in a statement.
If a bipartisan agreement is reached, Republicans would have to bridge divides within their own ranks. Conservative senators want a complete repeal of the ACA, while moderate Republicans prefer to retain some parts of the ACA, such as protections for people with pre-existing conditions. South Carolina Republican Senator Lindsey Graham proposed keeping the ACA’s taxes intact, but giving states more control over how those funds are spent.
For now, it appears unlikely the Senate will vote on a healthcare package anytime soon, although President Trump today (July 19) urged GOP senators to come up with a plan to repeal and replace the ACA before the summer recess. “We have to hammer this out and not leave town,” he told the senators.
Other news reports indicate GOP leaders intend to focus on other legislative topics, such as tax reform and the debt ceiling. Given the recent history of healthcare reform on Capitol Hill, which had been declared dead only to be revived weeks later, insurance agents should keep up on the debate and possible changes to healthcare so they can inform their clients.