Health plans beware: Industry experts predict it will take several months for final action on the Trump administration’s newly revived push to overhaul the Affordable Care Act (ACA). Despite the House’s narrow passage of an amended American Health Care Act (AHCA) May 4, they say the swell of insurance market uncertainty likely won’t subside until year’s end.
“I think it’s going to take most of the rest of the year for any resolution to this,” says Bob Laszewski, president of Alexandria, Va.-based Health Policy and Strategy Associates….If the Senate passes legislation, it must return to the House for reconciliation. The bad news is I don’t see any clarity for plans until the end of the year,” so insurers must decide 2018 pricing and products amid market uneasiness, he says.
The bill, which faces strong Senate pushback and public opposition, is not expected to become law as written. Forecasting the tough road ahead, hours before the House vote Sen. Lindsey Graham (R-S.C.) tweeted: “A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution.” Sen. Bob Corker (R-Tenn.) told MSNBC the House bill has “zero” chance of passing the Senate in its current form.
The GOP bill’s latest iteration was rushed to the House floor sans scoring by the nonpartisan Congressional Budget Office (CBO). In March, CBO estimated 24 million people would become uninsured, and Medicaid would lose $880 billion in funding, over a decade under the original bill’s terms — prompting House Speaker Paul Ryan (R-Wis.) to postpone the vote, make revisions and rally GOP support.
Proponents touted the MacArthur amendment, attached in April, that would give states more flexibility on essential health benefits and age-band ratings and relax protections for some people with pre-existing health conditions (HPW 5/1/17, p. 3). They also promoted a revision the night of May 3 tacking another $8 billion over five years to high-risk-pool funds.
Opponents also were vocal. Blue Shield of California’s chief executive called the AHCA “flawed,” asserting it would make health insurance unaffordable for millions of Americans by slashing premium tax credits and provide insufficient funding for high-risk pools.
President and CEO Marilyn Tavenner of America’s Health Insurance Plans (AHIP) stressed the need for “certainty now” on federal cost-sharing reduction (CSR) funds. She issued a more neutral statement than many health care organizations, saying the bill “needs important improvements” to keep private-market coverage accessible and affordable.
“I would say the bill leaves the entire individual market in great uncertainty,” says national health policy expert Timothy Jost. “But the non-funding of the CSRs and the Trump administration’s equivocation on them is the most immediate problem.”
According to Laszewski, “Trump’s not going to take cost-sharing subsidies off the table until he resolves all of this.” He describes subsidy funding as likely to involve month-to-month decisions.
“Plans won’t get any more direction, any clarity on cost-sharing subsidies…[and] no reinsurance subsidies for 2018 they can count on,” Laszewski says. “What you see is what you get.”