Minnesota Public Radio
(MN)
Republicans officially pulled the
plug on their last-ditch effort to repeal and replace the Affordable Care Act
on Tuesday.
"We don't have the votes,"
said Sen. Bill Cassidy, R-La., after a closed-door meeting of Senate
Republicans.
"And since we don't have the votes, we've made the decision
to postpone the vote." Cassidy, along with Sen. Lindsey Graham, R-S.C.,
put together the proposal they hoped could pass the Senate.
As of Sunday, though, the Senate will
no longer be able to pass a health law overhaul bill with only a simple
majority. That means the bill is effectively dead, for now.
That message was underscored by
Senate Majority Leader Mitch McConnell, R-Ky., who said, "Where we go from
here is tax reform."
But that does not mean all is smooth
sailing for the ACA. Here are five ongoing challenges the law faces.
1. Insurers still face tremendous
uncertainty.
Wednesday is the deadline for health
insurers to finalize rates for the 2018 individual market open enrollment
season, which starts Nov. 1. Yet there has been no resolution to the question
of whether the federal government will continue to reimburse insurers for
subsidies known as cost-sharing reductions. Those are payments insurers are
required to provide to moderate-income enrollees to help them afford
deductibles and out-of-pocket costs. The law says the federal government is
supposed to make those payments, but a lawsuit has left that an open question,
and the Trump administration has repeatedly threatened to stop making the
payments.
Without reimbursement of those
subsidies, Pennsylvania Health and Human Services Secretary Teresa Miller told
the Senate Finance Committee Monday, insurers in her state "reported they
would need to request a statewide average increase of 20.3 percent" in the
cost of health plan premiums. Those increases are similar nationwide.
A bipartisan effort led by Senate
Health, Education, Labor and Pensions Committee Chairman Lamar Alexander,
R-Tenn., and Patty Murray, D-Wash., to advance legislation to affirmatively
fund the payments was reportedly progressing until Republican leaders stopped
them to concentrate on efforts to pass the Graham-Cassidy legislation.
But Alexander and Murray now appear
back at it.
Murray said Tuesday she is
"ready to keep working on the bipartisan path that could lead to
results."
Alexander similarly released a
statement that he would "consult" with Murray and others "on a
limited bipartisan plan that could be enacted into law to help lower premiums
and make insurance available to the 18 million Americans in the individual
market in 2018 and 2019."
2. The Trump administration has cut
funding for efforts to sign people up for insurance.
Administration officials announced
earlier this month major cuts to the "navigator" program, which
provides funding to community groups that guide people through the complex task
of signing up for health insurance through the online marketplaces. Some groups
are losing more than 90 percent of their budgets.
The cuts have forced many groups to
lay off workers just before open enrollment begins and to limit the areas they
serve.
3. The 2018 enrollment period is half
the length of 2017's, and now it will be shorter still.
Trump officials are also slashing by
90 percent the advertising budget that reminds people about open enrollment and
how to sign up - from $100 million to $10 million.
Those cuts are even more significant
this year because for the first time since the law's implementation, open
enrollment starts in November, rather than December, and lasts only 45 days.
"Most people don't know the open
enrollment dates, and they don't know that the deadline this year is Dec. 15,
not Jan. 31, like last year," wrote Lori Lodes, who ran outreach for the
ACA in the Obama administration, in a recent op-ed for Vox.
Trump administration officials said
they don't think advertising is cost-effective, but Lodes wrote that "my
office produced reams of data that proved the overall effectiveness of outreach
advertising."
Additionally, HHS announced late last
week that it will shut down HealthCare.gov for maintenance from 12
a.m. to 12 p.m. every Sunday during open enrollment, except for Dec. 10 – a step critics say could further
undermine enrollment efforts.
4. The Trump administration is
dragging its feet on giving states flexibility to stabilize their markets.
Back in March, Health and Human
Services Secretary Tom Price and Centers for Medicare & Medicaid Services
chief Seema Verma, who oversees the ACA, sent a letter to states encouraging
them to use the law's waiver process to improve the functioning of their
individual insurance markets. In particular, they suggested states could create
"reinsurance" programs that would help lower premiums by providing a
payment mechanism for the most expensive patients.
But when Minnesota took up that
invitation, the administration delayed its response. When it finally did grant
permission last week, HHS also informed the state that it will lose significant
funding for a program that provides insurance to the state's low-income
residents.
Gov. Mark Dayton, a former Democratic
senator, said in a letter to Price that "we have now been informed that
Minnesota would lose more federal Basic Health Plan funding than we would
receive in federal support for reinsurance," and described the entire
waiver process as "nightmarish."
5. Republicans could take another
shot at a full overhaul next year - or even this year.
While the acknowledgment that the GOP
lacks the votes to overhaul the health law means an immediate vote will not
happen, the Republicans have potentially two more shots to try to pass a bill
with a simple majority vote.
What triggers the ability to pass a
bill in the Senate without threat of filibuster is a formal budget resolution.
Republicans have still not passed a budget resolution for fiscal 2018, which
begins Oct. 1. The upcoming resolution is expected to call for a major tax cut bill.
Some Republicans, notably Graham himself, have suggested adding health language
to that resolution, which would be allowed.
But that would complicate efforts for
both bills.
More likely is that Republicans could
try again for a health overhaul via its fiscal 2019 budget resolution, which is
due next April. That would leave them only a few months before the 2018
elections. Still, it's possible, particularly if they can use the time to reach
consensus.
That is clearly what sponsors of the
latest GOP bill have in mind.
"We're on a path to pass"
his bill, Graham told reporters. "It's just a matter of when. It will be
in this Congress, under a better process."
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Kaiser Health News, a nonprofit
health newsroom, is an editorially independent part of the Kaiser Family
Foundation.
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