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Are ACA repeal efforts over? Experts weigh in


In the wake of the failure of the Graham-Cassidy bill, experts share what’s ahead for health policy.

In the wake of the failure of the Graham-Cassidy bill, managed care executives should remain watchful when it comes to what’s ahead for health policy.

That’s according to several experts who spoke to Managed Healthcare Executive just after learning there would be no vote on the bill designed to repeal and replace the ACA.


“Now is the time to brace for increased uncertainties, financial challenges and operational issues for insurers, providers and beneficiaries,” says Jay Wolfson, DrPH, JD, distinguished service professor, Public Health, Medicine and Pharmacy, and senior associate dean, Morsani College of Medicine, University of South Florida Health.

“The ACA remains actuarially and structurally flawed. It has been since it was crafted and its authors noted that, expecting to ‘fix it later,’” Wolfson says. “Later never came for the Democrats after the mid-term election in 2014.”

Wolfson says uncertainty remains for health plans regarding how to stabilize premium rates without either subsidies or an enforced mandate (the latter creating larger risk pools), and how un-subsidized beneficiaries can expect to afford both the very real premium increases and concomitant deductible and copayment rates that have already made practical use of individual policies too costly. 

“For many beneficiaries, ‘having insurance’ will not equate to having access,” Wolfson says. “And without an enforced mandate, insurers may find that their beneficiary pools will become more unstable and costly.”

Not over yet


John Steele, partner at HealthScape Advisors consulting firm, anticipates more efforts to chip away at the ACA even without a full repeal and replace.

“There will be interest of some Republicans to try and eliminate items such as the individual mandate in the upcoming tax reform bills,” Steele says. “As for 2018, insurers will likely have uncertainty around the funding of the cost-sharing reductions unless there is enough bipartisan interest to pass a stabilization measure committing to the funding.”

Republican legislators cannot tell supporters they will do nothing more to undo major parts of the ACA, says Bob Atlas, a strategic advisor and president of consulting firm EBG Advisors, Inc.

“They are already talking about reigniting the effort in the FY 2018 budget reconciliation process, though that would likely be a heavy lift given their plan to enact major tax reform using the same vehicle,” Atlas says. “Perhaps they will promote a slimmer measure that would be more palatable to moderates, for instance, by not trying to rework federal Medicaid financing. Of course, their Medicaid proposal serves two key GOP aims: cutting entitlement spending to help fund tax cuts and shifting control of health policy from Washington, D.C., to the states.”


For insurers, Medicaid managed care opportunities appear on track to continue for a long while, and likely to grow as states seek solutions for hard to serve populations such as long-term care users and Medicare-Medicaid dual-eligibles, Atlas says.

“Medicare Advantage is a safe harbor that has plenty of growth potential,” he says. “Employer group business will stay level, though even more of that business will become self-funded, which challenges insurers’ top-line revenue prospects. The individual market will continue to roil somewhat, because the Trump administration appears uninterested in stabilizing it for the long term.”

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