In the wake of yet another failed attempt to repeal and replace the Affordable Care Act, lawmakers and insurers alike are left with more questions than answers about what will happen next.
Lacking enough votes to pass Lindsey Graham and Bill Cassidy’s healthcare bill, the two GOP senators and Senate Majority Leader Mitch McConnell said Tuesday that they would not vote on the measure this week as planned.
“Am I disappointed? Absolutely,” Cassidy said at a news conference. But both he and Graham suggested the bill wasn’t entirely dead. As Graham put it: “It’s not if, it’s only a matter of when” the measure will pass.
Similarly, President Donald Trump suggested on Twitter that the GOP’s repeal-and-replace efforts are not over.
We will have the votes for Healthcare but not for the reconciliation deadline of Friday, after which we need 60. Get rid of Filibuster Rule!— Donald J. Trump (@realDonaldTrump) September 27, 2017
In theory, Republicans could write new budget reconciliation instructions for 2018 that would allow them to tackle both healthcare and tax reform, according to the Brookings Institution. Yet that might be easier said than done, as the party has already struggled to agree on what such a budget resolution would look like—even without adding healthcare into the mix.
Indeed, both House Freedom Caucus Chairman Mark Meadows and Senate Majority Whip John Cornyn said Tuesday that they are opposed to combining tax reform with an ACA repeal effort in a single budget reconciliation measure, The Hill reported.
Other lawmakers, meanwhile, want to resume bipartisan work on healthcare policy.
Tennessee Republican Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, indicated he is willing to restart talks with Democrats on a bipartisan solution to stabilize the ACA exchanges. The HELP Committee’s work on such a measure stalled when the Graham-Cassidy bill began to gain steam.
“I will consult with Senator [Patty] Murray and with other senators, both Republicans and Democrats, to see if senators can find consensus on a limited bipartisan plan that could be enacted into law to help lower premiums and make insurance available to the 18 million Americans in the individual market in 2018 and 2019,” he said in a statement.
Implications for insurers
America’s Health Insurance Plans—which joined several other major healthcare industry trade groups in opposing the Graham-Cassidy bill—seems likely to support an effort to resume ACA stabilization talks.
“The industry remains committed to serving those who buy their own coverage or rely on Medicaid for coverage and care,” AHIP spokeswoman Kristine Grow said. “We will continue to work in a bipartisan way to offer our recommendations for improving care and coverage for all Americans.”
Yet today is the final day for insurers to sign contracts that finalize their plans for participating in the ACA exchanges—a deadline is likely to pass with the industry gaining no additional certainty about the future of cost-sharing reduction payments. The Senate HELP Committee was aiming to craft a measure guaranteeing the payments for at least one more year, but lacking any definitive action, some states have already approved steep rate increases for ACA exchange plans.
Meanwhile, the upcoming open enrollment period for the ACA marketplaces is looking like it will be far from business as usual. The shortened sign-up window, funding cuts for advertising efforts and navigators, and the Trump administration’s decision to shut down Healthcare.gov for several hours every Sunday could all dampen enrollment—which might not bode well for the already volatile individual markets.