Congressional wrangling driven by a handful of dynamics

It all comes down to math.

Strong opinions have already formed about the Affordable Care Act (ACA) replacement plan that was announced by President Trump during the first week of March. Several factors are in play that will determine the outcome of the new American Health Care Plan (AHCA) currently wending its way through a process maze.

  • The budget test. Everything Republicans hope to pass through budget reconciliation must meet certain tests. While it requires fewer votes for Congress to take action using the budget reconciliation process, these actions are restricted to budget matters. So while they can repeal taxes through this mechanism (for example), rules about insurers covering pre-existing conditions would be unaffected by budget reconciliation.
  • The rift. Factions within the Republican Party and Democratic opposition to the AHCA may add up in such a way that its passage is impossible. The voting margins as currently aligned are very slim.
  • Momentum. Proponents of the proposed legislation want to push this forward quickly and are aiming for a House bill to be finished before they recess April 7 through April 25. (See the congressional calendar for 2017 here.) With a numbered set of days in a congressional year to pass legislation, the clock is ticking for a crowded agenda.
  • Timing. Another way in which timing is important is that insurers need to submit plans in June for 2018 health plans, even if parts of a repeal wouldn’t become effective for years. Market instability can’t help but affect payers’ calculation of risk even if implementation is years off. The deadline for filing plans and rates has already been extended once by the president, from May to June 2017.
  • Scoring. Perhaps most important, what will the Congressional Budget Office analysis have to say about the costs and implications of passing the AHCA in any form? Or any new plan, for that matter?

After budget reconciliation, phase two will come in the form of any administrative actions Tom Price elects to take as secretary at the U.S. Department of Health and Human Services. What he intends to do is not known at this time. For phase three, a safe assumption is that AHCA advocates will try to pass new legislation that addresses any remaining issues.

Regardless of what happens next, part of any business calculation should be to work with the right partner in navigating healthcare’s clinical and administrative complexities. ABILITY can be a steady resource during a time of profound change and uncertainty. For more on industry issues, click here.