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What's Ahead for the ACA?

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What's Ahead for the ACA?

by: 
Rodney L. Whitlock, PhD, Vice President, Health Policy ML Strategies, LLC

Last week began with a flurry of activity around the idea that Republicans might be willing to take another shot at health care reform. This should not be surprising. Republicans cannot go back to their base and their donors and tell them “we gave up.” By the end of the week it is obvious that they are nowhere close to coming out with an American Health Care Act (AHCA) redux. The political squabble between the Administration and the Freedom Caucus compounds the fact that Republicans cannot dig themselves out of their previous position on the AHCA without showing the substantive policy that makes them change their position.

We definitely can reset and catch our breath as the meteor has missed us. But it is wrong to think that health care is done for the year. Opportunities and challenges are coming.

Republicans argue the Affordable Care Act (ACA) is failing. Objectively, it is not failing broadly, yet it is on thin ice in many places. If the President wants it to “explode” nationally, he will have to push the plunger. An example would be ending cost sharing reduction payments. But doing so would obviously be causing the ACA to explode; not something you could blame on Barack Obama. At this point, it is not clear how the Administration will cause the ACA to explode covertly and if that is even possible.

However, the ACA could fail in specific areas. Marketplaces could collapse in certain states (I’m looking at you Oklahoma and Tennessee). Some argue that Republicans will own failure of the ACA, even on regional basis, if they do not do everything they can to make it succeed. Republicans certainly don’t see it that way. We may soon find out which is right.

Assuming Republicans do not overtly explode the ACA, the moment for next steps comes after June 21st, the day health insurers have to decide whether they will sell coverage on the Marketplaces in fiscal year 2018. If there are a number of counties/states without coverage, it will spur a political/policy conversation. There will be conservations around health care reform prior to that date, but it is unlikely they will produce momentum, certainly not the momentum that could occur if the ACA is failing in certain areas.

Beyond actions directly related to the ACA, next up is a health care minibus. The health care minibus includes all the health care extenders left behind from MACRA - CHIP, MIECHV, community health centers, therapy caps, SNPs, and DSH. These provisions open the door for numerous policy areas to come up in the form of amendments. It is also unclear what will pay for all of the extenders. Discussions on these policies should percolate mid-summer due to the need for states to have certainty around CHIP funding.  Additionally, we have user-fee-agreements coming down the pike.  We all wait with baited breath to see if it includes policies related to drug pricing.

On the regulatory front, we expect a lot of activity from the new CMS. There is certainly an expectation that CMS Administrator Seema Verma will promote creativity in the Medicaid program, which will likely be accompanied legal activity from the stakeholder community. We should expect many CMS actions to end up with a lawsuit ending in “v. Price.”

So where does this put us?

The meteor has missed us. There is limited expectation that Republicans will come back with anything in the short term. Now we work to accomplish our short term goals and defend ourselves against potential challenges.

 

Rodney is a veteran health care policy professional with more than 20 years of experience working with the US Congress, where he served as health policy advisor and as Acting Health Policy Director for Finance Committee Chairman Chuck Grassley of Iowa and, earlier, on the staff of former US Representative Charlie Norwood of Georgia. Rodney Whitlock also serves as one of ANCOR's lobbyists.