Replacing the ACA: A Battle was Won, But the War Isn't Over

Fight must go on even after AHCA failure, ACP leader says

SAN DIEGO -- The American Health Care Act (AHCA) may be in retreat for now, but the fight to repeal and replace the Affordable Care Act (ACA) isn't over, a health leader here warned.

The American College of Physicians (ACP) was "the leading physician organization" to oppose the AHCA, said Bob Doherty, ACP senior vice president for government affairs and public policy at the ACP meeting, noting that the plan would have had many negative repercussions -- cutting Medicaid by about $370 billion over 10 years; pulling funding from Planned Parenthood; and shifting the tax credits from income-based to age-based.

The latter would have left older, sicker, poorer patients with little hope of paying for coverage, Doherty said.

He also noted that the plan would have opened up a loophole on guaranteed issue, by allowing insurers to charge individuals more if they do not maintain continuous coverage.

Of course, Doherty highlighted the estimate from the Congressional Budget Office that 24 million people would lose their insurance over 10 years as a result of the AHCA.

Lastly, Doherty pointed out 11th hour amendments to the bill that would have eliminated the ACA's essential health benefits, without which "insurance would be meaningless."

Despite dodging the AHCA bullet, "the story doesn't end here," he said, adding that through "action or inaction," the Trump administration could still reverse this important victory for ACA-defenders.

Future obstacles to the continuation of the ACA include a lawsuit targeting cost-sharing subsidies; the administration's resistance to advertising ACA plans; and the uncertainty as to whether the administration will fight to stabilize the health insurance market. Prior efforts to implement risk corridor payments, which might have prevented some companies from leaving the exchanges, were viewed as bail-outs by conservatives, Doherty noted at an ACP press conference on the AHCA.

"The question is, will this administration faithfully execute it?" Doherty said of President Obama's signature health reform law.

After the November elections, House Republicans hit the pause button on a court battle,Price v. Burwell (formerly House v. Burwell), arguing that direct payments to insurers to help subsidize poorer beneficiaries were never legally appropriated under the ACA.

Policy experts have said the battle was waged to gain leverage against the Obama administration, with Trump and Price at the helm, but now pits Republicans against themselves.

If the appeal is dropped, the "nuclear option" -- a lower court decision stating the dollars had been dispensed illegally -- would stand and insurers would very likely flee the exchange, Doherty noted.

If the administration appropriates the money for the cost-reduction, as liberal policy experts hope, it could avert the potential upheaval to the market and prevent millions of people from losing their insurance.

Doherty stated that the administration balances out adverse selection -- the challenge of having too many older sicker beneficiaries as opposed to healthy ones -- through increased marketing and advertising to young people. So far, the administration has been reluctant to make these investments.

Finally, Doherty said that efforts within the Republican caucus to bring back back the AHCA are ongoing, despite the fact that only 17% of Americans supported the AHCA, according to a Quinnipiac University poll.

If the Trump administration and Congress try to re-initiate the same policies as outlined in the AHCA, they will be "going against public opinion," Doherty asserted.

This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.