With Republican leaders confirming that repealing the Affordable Care Act is a top priority after Tuesday’s election and the law’s defenders vowing to fight for it, the health insurance industry is left to cope with a lot of uncertainty.
"A total war footing"
When asked Wednesday whether Republicans would move forward with plans to repeal the healthcare reform law when they control both Congress and the White House, Senate Majority Leader Mitch McConnell said that “it is a pretty high item” on their agenda. “I would be shocked if we did not move forward to keep our commitment to the American people,” he said.
Even so, White House Press Secretary Josh Earnest said President Barack Obama would lobby President-elect Donald Trump to keep his signature legislation intact, according to the New York Times. Supporters of the law are also gearing up to defend it.
“This will have tragic consequences for tens of millions of people, and we at Families USA are going to be on a total war footing to make sure this never comes about,” the left-leaning advocacy group said in a statement.
Dismantling the entire structure of the ACA, "root and branch," would be difficult, attorney Beth Halpern, a partner at the Washington, D.C., offices of Hogan Lovells, told FierceHealthPayer.
Campaign rhetoric touting repeal and replace overlooks the practical processes: Translating the talking points into legislative language, holding swaths of committee meetings and hearings, awaiting public comments and then undertaking the implementation itself, she said.
The last step could prove time-consuming, especially, as the 1,000 page-plus ACA involves interagency cooperation of the Social Security Administration, the Centers for Medicare & Medicaid Services, the Department of Health and Human Services and the IRS.
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A full repeal of the ACA would face a filibuster in the Senate, where Democrats have enough votes to stop it, health legislation expert Tim Jost, J.D., writes in a Health Affairs Blog post.
But Congress could repeal many of the law’s key provisions using the budget reconciliation process--in fact, the reconciliation legislation vetoed by Obama in 2015 provided a blueprint to do so.
Money "down the drain"
However changes are implemented, health plans must respond, Halpern said. Proper plan design and product pricing have proved notoriously difficult since the passage of the ACA.
“It’s going to take a while,” she said.
Many insurers may find it difficult--and costly--to adjust to a post-ACA landscape, healthcare consultant Rita Numerof, Ph.D., told FierceHealthPayer.
“I think there’s going to be real angst and disappointment that they’ve followed the rules, they’ve put all these things in place to be consistent with regulations that have emerged over the last several years,” she said.
“As those regulations change, that’s going to have to be dismantled. So that’s money, in essence, poured down the drain.”
Katherine Hempstead of the Robert Wood Johnson Foundation also expects insurers to be worried about the prospects of an ACA repeal.
Industry "understandably skittish"
“The industry is understandably skittish about the prospect of changes that would result in a large net reduction in public subsidies, since this would most likely shrink the market and increase the uninsured population,” she said in an email.
Still, Numerof said she is hopeful that a new presidential administration will have an opportunity to get health reform right.
“It would be problematic for this country to go back to the situation that we were in before, because it clearly wasn’t working,” she said.
Plans for a "robust" marketplace
The Blue Cross Blue Shield Association offered a similarly optimistic view.
“As health insurers for one in three Americans, we look forward to working with the new president and Congress to improve our healthcare system and ensure that Americans have access to high-quality healthcare at a price they can afford,” BCBSA CEO Scott Serota said in an email.
“In particular, we are sharing ideas for improving the individual market, so that consumers have more choices, better prices and a robust private marketplace that is predictable and stable.”