How midterms, polls, and CBO score could influence health care reform

It’s no secret that health care reform has hit some bumps in the road to becoming reality. It seems to be in start-and-stop mode, jumping forward a few feet before it pauses, reverses, and then slowly inches forward again.

While the timeline for Affordable Care Act (ACA) reform is tough to pin down, there are several factors that may speed up the process or slow it down. Some have already happened, some are due to happen soon, and others might not happen at all. Each of these elements could come into play as we await the Senate’s proposed version of health care reform legislation.

Here are a few factors that could send health care reform speeding through the legislative process, or seriously pump its brakes.

Speed it up

  1. Insurers pull out of the market. Trump has been threatening to allow the ACA to “death spiral” since the campaign trail, and this is one way that could happen. With several insurers recently pulling out of the market for 2018, it’s a legitimate concern. If insurers continue this pattern, a huge number of people could be left with no insurance in their area. Prices from the remaining insurers could skyrocket, and health care would become unaffordable. Lawmakers might work a little faster to pass their new plan if they saw signs that this trend was accelerating.
  2. Midterm elections approach. Republicans—especially moderate Republicans—are facing a dilemma. On the one hand, they campaigned on repealing and replacing the ACA. On the other, the plans to do so could reduce the number of people covered. As midterm elections approach, it’s possible that moderates will start jumping on board with whatever plan is available, so they can at least say they fulfilled this particular campaign promise.
  3. Moderate Republicans team up with Democrats. In the unlikely event that a group of Republicans decide that “amending” the ACA is good enough, reform could at least take some substantial steps forward. Bipartisanship doesn’t seem likely, and it may take a while to work through the initial kinks. But if a bipartisan bill made it to a vote, it would probably pass easily.

Slow it down

  1. Party division continues. So far, this has been the number one factor in slowing down the Republican health care plan—and it’s unlikely to go away any time soon. While the House bill has undergone some revisions that seem to satisfy conservatives and moderates alike (at least to some extent), the Senate needs to pass its own version of the bill—one that will eventually have to match up with the House. The Senate also has divisions between moderates and conservatives, but leans more moderate in general, which could be an issue when the two chambers have to reconcile their bills.
  2. CBO score implications. The CBO’s latest score of the AHCA confirmed many concerns about the bill and has given Democrats more ammo to halt progress. The CBO estimated that if the AHCA becomes law, 23 million more Americans would be uninsured by 2026, insurance plans would cover fewer conditions, and costs may increase drastically for older Americans and those with pre-existing conditions (as compared to the ACA). While the CBO did reveal some positive aspects, such as reducing the federal deficit by $199 billion over 10 years, the negative consequences have many calling for the Senate to make major bill changes.
  3. The ACA becomes more popular. Polls continue to show that the ACA is gaining, rather than losing, favor as Republicans roll out their newest replacement plans. The health care bill’s popularity has fluctuated since it was instated in 2010, but it’s now polling at some of its highest levels ever, and it’s favored by more Americans than the AHCA. It’s possible that, if these numbers get high enough, the repeal effort could falter.
  4. Democrats win the 2018 midterm elections. With all the dissatisfaction surrounding the AHCA, it’s possible we’ll see another political shakeup in 2018. If Democrats were to take back even a slight majority in one of the chambers of government, this would probably cement the ACA’s place and kill any chance of repeal. That’s not to say that amendments and repairs wouldn’t be possible—but it’s unlikely a full “repeal and replace” effort would resurface after this point.

It’s difficult to predict the future of health care reform. It will probably take a while, if the passing of the AHCA by the House is any indication, but any of these factors could influence the timeline. In the meantime, make sure to keep up on your reporting efforts—no matter what, it’s going to be a while until we see any change.