The GOP health care proposal is dead for now. But can Republicans repeal the ACA by other means?
Despite furious last-minute lobbying by President Trump and House Speaker Paul Ryan (R-WI), a group of conservative representatives quashed the GOP-sponsored Obamacare replacement proposal on Friday. Without enough votes to pass the bill, Ryan pulled the American Health Care Act before it came before the House floor for a full vote.
“Obamacare is the law of the land,” Ryan said after announcing the bill’s failure to garner House approval. “We're going to be living with Obamacare for the foreseeable future.” The AHCA’s collapse handed Republicans a stinging defeat for what was touted as their signature legislative promise — the outright repeal and replacement of the Affordable Care Act.
Why it Failed
Two factions of the Republican party were responsible for the failure of the AHCA — ultra-conservatives and moderates. Of the two bodies, the hardline conservative Freedom Caucus railed hardest against the bill, in particular because the bill did not immediately eliminate the set of taxes that support Obamacare. They also sought to end Medicaid expansion sooner than the GOP bill stipulated (in 2020), and further objected to the AHCA’s refundable tax credits.
The GOP proposal did include some components that conservatives wanted, however, which included reduced subsidies and the repeal of the individual mandate. In a last-ditch effort to curry the Freedom Caucus’ favor, Ryan and other Republican leaders agreed to drop federal rules requiring minimum health care benefits such as maternity care, emergency services, prescription drugs, and mental health treatment. Those concessions weren’t enough to sway Freedom Caucus members, however, who aimed for fewer insurance regulations and more market-based solutions to bring down costs.
The AHCA also lacked support from moderate Republicans, who primarily raised concerns over the number of people that the act would have left uninsured — a belief reinforced by boisterous town hall meetings full of constituents afraid of losing their health insurance. The American Medical Association and the American Hospital Association voiced opposition to the bill as well.
What Happens Now
Following the retraction of the AHCA, President Trump stated that he planned to focus on other policy priorities. Instead of attempting to overhaul the initial proposal to make it more palatable to conservatives, Trump said he envisioned Obamacare ultimately collapsing.
“Obamacare, unfortunately, will explode,” Trump told the New York Times. Eventually, if premiums rise even further, the president believes Democrats may be willing to work with Republicans on a solution. “Democrats will come to us and say, ‘Look, let’s get together and get a great health care bill or plan that’s really great for the people of our country,’” Trump said.
Nevertheless, even without a federal law, the White House has the power to amend Obamacare. “The Trump administration has a great deal of flexibility to make changes that don’t require congressional approval,” Senior Vice President at Avalere Health Elizabeth Carpenter told Consumer Reports.
Health and Human Services Secretary Tom Price also stated his intention to reduce federal regulations on the essential health care benefits insurers must offer. President Trump could also chip away at the ACA’s mandates through executive orders, as he did when directed federal agencies to reduce burdensome taxes.
Obama’s Signature Legislation Safe — For Now
Clients covered by Obamacare exchange policies now know that there will be no immediate changes to their coverage. In addition, the CBO report stated that the individual non-group health insurance market “would probably be stable in most areas under either current law or the [AHCA].”
Still, legislators could revisit the contentious proposal in the future. And as the Consumer Reports article suggests, the White House may decide to revise some of the ACA’s provisions without Congressional action. For example, HHS might allow insurers to offer policies without ACA-mandated benefits such as maternity care, mental health therapy, emergency services, and prescription drugs. By doing so, premiums might be reduced, but your clients may find themselves without coverage in the event of an unexpected medical crisis.
The best advice you can give your clients is to maintain their current health insurance policy. If they do decide to switch plans, make sure the premiums are affordable and that the contract covers all of their current and future medical needs.