Despite multiple efforts of the Trump Administration and many Republicans in the House and Senate to repeal and replace the ACA in 2017, the ACA is still the law of the land. Nonetheless, healthcare experts predict that repeal efforts will continue and other healthcare-related policy changes will develop in the new year.
“There will be many opportunities for the GOP to continue pursuing repeal efforts; changes can almost always be tacked onto or incorporated into another bill,” says Matthew Fisher, Esq., partner and chair of the health law group at Mirick O’Connell, a full-service law firm.
Those efforts will continue to be challenged, however, perhaps even more strongly than ever, by Democrats, who saw promise from the November 2017 elections. They might be emboldened to further fight efforts to repeal any portion of the ACA, Fisher says. “While it is hard to fathom that the Democrats have not been utilizing every tool to fight GOP efforts on the repeal front, if Democrats believe that the electorate is behind their efforts, then Democrats will continue using every tactic at their disposal.”
But the November election results could also push the GOP to fight harder to make changes to the ACA, as the GOP might interpret the results as a sign of voters being unhappy with a lack of action, Fisher says. “While controlling both chambers of Congress and the presidency, no major legislation was enacted. As such, the GOP may feel even more pressure to do something. Ultimately, the outcome from the election likely means that stalemate will continue to rule in Washington.”
Past experiences with failed efforts may also impact strategy going forward. “Republicans might use reconciliation to remove the practical 60-vote threshold in the Senate and try to cut deals that make provisions palatable to secure at least 50 votes,” Fisher says.
Here are four other policy developments to watch in 2018.
1. Reinsurance payments to insurers
Trump eliminated cost sharing reduction (CSR) payments on October 12. “When these payments to insurers are cut, insurers typically increase premiums to cover this loss,” says Rosemarie Day, president, Day Health Strategies, a healthcare strategy and transformation consultancy. “For 2018, insurers have mostly loaded these premium increases onto silver plans. As the silver plans’ premiums increase, the individual Advance Premium Tax Credit (APTC) from the federal government will also increase because APTCs are based on the second-lowest cost Silver level plan. Since the APTCs increase as rates increase, individuals that receive subsidies are unaffected by the rate increases.”
Interestingly, Day says, while the federal government will not have to spend money on CSR payments to insurers anymore, it will actually end up spending equal or more money because APTCs increase. “In the end, the insurer is made whole by increasing rates, the subsidized are buffered by federal government subsides, and the unsubsidized get hammered by rate increases,” she concludes.
However, a new bill could change all this. Introduced on October 17 by Senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the Alexander-Murray bill would reinstate CSR payments. “CSR payments would go to insurers and then they could lower rates, which would lower costs of premiums for the 2019 plan year,” Day says.