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Next Steps on Affordable Care Act Remain Uncertain

March 29, 2017

Both Congress and the Administration are assessing next steps with respect to the Affordable Care Act (ACA) in the wake of the U.S. House abandoning a floor vote on the American Health Care Act (AHCA). This proposed legislation would have partially repealed and replaced the ACA and made significant changes to the Medicaid program. 

Although legislative leaders, including House Speaker Paul Ryan, have reaffirmed their desire to consider legislation that would repeal the ACA, there is no immediate or clear policy path ahead. Republican leaders in the House are assessing if they can unify the diverse perspectives within the Republican House Conference. Meanwhile, others, including members of the Pennsylvania delegation, the President, and key Republican senators have pointed to the potential for a bipartisan approach.

Forty-four Senate Democrats signed a letter indicating they would work with President Trump on health care reform—including stabilizing the individual insurance market—but only if he rescinds his January 20 executive order targeting the ACA.

The Trump Administration can exercise certain authorities to either stabilize or undermine the law. U.S. Secretary of Health and Human Services (HHS), Tom Price, testified before the U.S. House Labor, HHS Appropriations Subcommittee today and was questioned about the Administration’s approach. 

A chief concern is how the Administration will handle an outstanding lawsuit that would block subsidies intended to reduce out-of-pocket costs for individuals with incomes below 250 percent of the federal poverty level who purchase coverage through the insurance marketplaces. The cost-sharing reductions help lower deductibles, co-pays, and out-of-pocket costs for nearly 6 million Americans. If the payments are not made by the federal government, it is expected that insurers will drop out of the market. 

During his testimony, Secretary Price indicated he could not speak to the Administration’s plans with respect to the cost-sharing subsidies because he is a party to the lawsuit.

Insurers must decide if they will participate in the insurance marketplaces by June. In February, the Administration issued a rule seeking to stabilize the insurance markets for the 2018 insurance plan year.  

When asked if he will enforce the “individual mandate”—a requirement that all individuals maintain coverage—Secretary Price indicated he is obligated to enforce the law as it currently stands. However, the Administration can act to reinterpret some elements of the law. For instance, they could redefine what benefits are included as “essential health benefits.” 

Secretary Price did reaffirm that the ban on denying coverage for pre-existing conditions will be maintained. 

Since the election in November, Pennsylvania hospital leaders have made the case for coverage. More than 1.1 million Pennsylvanians have benefited from health care coverage as a result of the ACA. That coverage has meant access to care—preventative services, less costly outpatient visits rather than hospitalizations, treatment for behavioral health and substance abuse—and ultimately, better health.
HAP has urged policymakers to engage in a deliberate and thoughtful process to make improvements to the ACA, and articulated that any replacement plan should:

  • Ensure continuity of coverage and care through access to a robust, competitive delivery system
  • Provide stable and sufficient resources for hospitals to deliver care
  • Maintain positive momentum in delivery system transformation and innovation

HAP and the hospital community remain committed to working with the Pennsylvania Congressional delegation and the Administration to identify opportunities to improve the ACA.

Please contact Laura Stevens Kent, HAP’s vice president, federal legislative advocacy, with questions.

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