The failure of Senate Republicans’ latest attempt to roll back the Affordable Care Act relieves health companies, but hospitals and insurers will quickly pivot back to worries about implementation of the existing law as the crucial open-enrollment season looms.
The bill, from Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, had drawn widespread opposition from hospitals, doctors and health insurers. The industry broadly condemned cutbacks to the Medicaid program, as well as a redistribution of ACA funding through block grants that would have left many states with less federal health-care support. Insurers and health-care providers said the bill would have left far fewer people with coverage.
“It’s a momentary bit of a relief,” said Gabriela Saenz, a vice president at Christus Health, a hospital system based in Irving, Texas, that opposed the bill. But hospitals remain worried about the stability of ACA marketplaces, because rising premiums or an exodus of insurers could leave more patients uninsured, she said. “We absolutely do have concerns with the sustainability of the market,” she said.
Health-care companies also feared chaos if the Graham Cassidy legislation passed, as states would have had to rush to come up with their own massive health-coverage revamps before 2020. The bill also failed to include one of health insurers’ top priorities, the repeal of an ACA tax on health plans, while it got rid of the ACA’s coverage mandate, which insurers argue is important in prodding healthier people to sign up for coverage.
“It’s time to move on,” said Sister Carol Keehan, president and chief executive of the Catholic Health Association of the United States, during a call held Tuesday by the American Hospital Association and other industry groups opposed to the bill. The Catholic group includes more than 2,000 Catholic hospitals and other healthcare providers.
Health-care industry officials remain wary of future attempts by Republicans to pass ACA-repeal bills, and of the likelihood that health care will remain an area of sharp partisan debate. Some Democrats are now backing the idea of a government health-care program for all Americans.
More immediately, insurers and other health-care companies say the death of the repeal bill still leaves questions about how the ACA would work going forward—particularly, what would happen with health-insurance exchanges, which are under strain due to both uncertainty about the Trump administration’s policies and underlying business challenges in some regions. About 10.3 million people get insurance through exchanges, according to the Kaiser Family Foundation, though others buy ACA plans outside the law’s marketplaces. The individual insurance market is far smaller than the share of Americans who get coverage from Medicare, Medicaid or employers.
Insurers face a Wednesday deadline to sign up to offer 2018 exchange plans. Though they are happy to dodge the risk that the coverage mandate would be repealed immediately, companies are still concerned about federal payments that are used to reimburse insurers for reducing costs for low-income ACA enrollees.