The Affordable Care Act is having a pretty turbulent ninth birthday.
That's right —it’s officially been nine years since the Affordable Care Act was signed in to law. And on Monday night, the Trump administration said in a letter to a federal appeals court that it backs a lower court judge’s ruling to strike down the law in its entirety.
About 24 hours later, House Democrats unveiled a plan to shore up the law.
The dueling documents make for a tale of two approaches to the ACA, creating additional uncertainty in the industry about the massive law whose impacts sprawl across the entire healthcare system.
Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute Center on Health Insurance Reforms, told FierceHealthcare that while the industry isn’t likely to see the full effects of the pending lawsuit this year, insurers building their rates for 2020 are likely to take it into consideration.
State insurance departments aren’t fond of “overly speculative” rate filings, Corlette said. But even if payers don’t spell their concerns out in black and white, they like finding ways to price for the ACA’s uncertain future.
That said, the chance that the ACA could be struck down has loomed for a long time, she said.
“Without a doubt, this litigation has created tremendous uncertainty, but the risk has been there all along that the whole ACA would be invalidated,” Corlette said.
Ashley Ridlon, vice president of health policy at Evolent Health, a company that works with Next Generation accountable care organizations, told FierceHealthcare that the ongoing court case won’t stop the march toward value-based care, at least for now.
Those in the market have grown to expect the back-and-forth over the ACA, anyway, Ridlon said.
“The law has faced so much uncertainty since its enactment that, to providers and the market, the legal uncertainty is just noise at this point,” Ridlon said. “Providers move forward until something major happens, in which case they adapt.”
The House Democrats’ opposing plan introduced Tuesday, the Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act, would allocate additional funding to reinsurance programs, federal subsidies for ACA plans and enrollment outreach.
It also would reverse the White House’s expansion of short-term plans—derided by Democrats as “junk” plans—to 12 months.
“Today, led by our freshmen, we are taking another big step forward to lowering healthcare costs for our American people,” House Speaker Nancy Pelosi said at an event unveiling the bill.
Industry groups gave the Department of Justice’s letter a thumbs down, expressing concern about its far-reaching effects, while some applauded the work in Congress to bolster and improve the ACA.
American Hospital Association President Rick Pollack said the DOJ’s position was “misguided.”
“The position is unprecedented and unsupported by the law or the facts,” Pollack said. “Millions of Americans would lose the coverage they have relied on for years.”
The American Medical Association and the Federation of American Hospitals, meanwhile, said they were both committed to working with Congress on solutions to strengthen the ACA and ensure that people have access to affordable care.
The healthcare law is responsible for “gains that most of us now consider essential,” said AMA President Barbara McAneny, M.D.
“Tens of millions of Americans depend on ACA health coverage and millions more could be covered,” FAH President Chip Kahn said. “This is why the federation sees the new initiative as mission critical to improve and protect care for the patients we serve.”