Uncharted Waters for Healthcare After GOP Plan Pulled

After the dramatic rise and fall of the American Health Care Act (AHCA), many in the healthcare industry are wondering what to expect next. After months of uncertainty, it seems relatively clear that the type of large-scale reform isn’t going to happen any time soon. President Trump and other Republicans have signaled that they are ready to move on to tax reform and other legislative priorities. Although Paul Ryan and other Republicans are trying to revive healthcare reform, it doesn’t seem likely that the fissure in the House of Representatives that doomed the AHCA is any closer to healing. And a great deal of momentum has been lost. With April recess looming, the process is slowed even further.

Some key issues to track:

April/May insurer decisions. Although they have until June to decide on which plans they want to offer and in which markets for 2018, insurers could start announcing their intentions in April and May for 2018 health plans. Their actions will reveal their best guess as to how risky Affordable Care Act (ACA) exchanges and the individual market will be next year. Insurers are said to be closely watching the administration and Congress to gauge whether they will try to stabilize the exchanges or let them falter. It’s a political gamble as to who would be blamed for such an outcome.

Lawsuits. As part of the trade-offs made during the building of the ACA, insurers were promised extra funds for several years through a “risk corridors” program designed to cushion the financial blow that was anticipated to come with the influx of sicker patients into the system. However, after the ACA was passed, congressional opponents of the ACA passed an amendment that did away with these payments and the lawsuits began. The outcomes of these lawsuits and their timing could dramatically affect the decisions insurers make about exchange participation.

Medicaid expansion. After a long wait-and-see period, the opportunity for states to accept the Medicaid expansion appears to be live again and there is interest from several states – Georgia, Kansas, Maine, North Carolina and Virginia. With a new secretary at the U.S. Department of Health and Human Services (HHS) in place, states will likely have more flexibility to design their own state Medicaid models with features like beneficiary work requirements. With that flexibility, some previously recalcitrant state legislatures and governors might find Medicaid expansion more attractive.

Administrative actions. The ACA was written in such a way that it gives great leeway to the secretary at HHS to take administrative actions that affect how the ACA is enforced – or not. HHS Secretary Tom Price has been a fierce opponent of the ACA and may make a political calculation as to how aggressively he will enforce the laws and policies over which he has authority. He stated March 29 that he would continue to enforce the individual mandate as long as the ACA is “the law of the land.”

As has been the case for months, healthcare is in uncharted waters.

Providers will continue to need help navigating clinical and administrative complexities as the industry evolves. ABILITY can be a steady partner during a time of profound change and uncertainty. Check out our resources here.