In the wake of the American Health Care Act (AHCA) being pulled twice by House Speaker Paul Ryan (R-WI) for failing to gain sufficient support to pass, Washington insiders have been sending mixed messages about where to go from here. (See WICs article, "ACA Remains Law for "Foreseeable Future" as Repeal Efforts Implode," March 27, 2017.) President Trump initially said he would welcome working with Democrats on future health care reform efforts, appearing to recognize that given the deep fissures in the Republican party, bipartisanship would be necessary to move any effort forward. Speaker Ryan, just days after proclaiming that "Obamacare remains the law of the land" for the "foreseeable future", again vowed to repeal the Affordable Care Act (ACA). However, others in the Republican party remain unmoved, with some members questioning what Ryan thinks has changed since the demise of the AHCA that would bring those opposed to the bill to the table.
As Congress moves into recess prior to the Easter holiday, it's expected that health care will remain front and center for constituents engaging in advocacy at the local level, including likely more contentious town hall events with constituents promising to hold responsible any lawmaker who works to take away health coverage from people who gained it under the ACA. Some states that had previously opted not to expand Medicaid are now exploring the possibility after the AHCA failed. This could cause an uptick in coverage, and costs, which could complicate future efforts to unwind the law.
Democrats are seizing on the failure of the AHCA as an opportunity to position themselves as reasonable partners in a real conversation about health care reform. Last week, 44 out of 48 Senators sent a letter to Trump offering to work on improvements to the ACA so long as repeal was off the table.
It remains to be seen whether the closed-door conversations happening now in Washington will result in a viable health care reform package, or whether the administration and Congress will move on to tax reform, which appeared at the end of last week to be the most likely course of action.