Is ACA ‘repeal and replace’ dead?

On Friday, March 24, moments before a vote was scheduled on the much-debated American Health Care Act (AHCA), Republican leadership, in coordination with the White House, pulled the bill. It was clear the AHCA was not going to have enough Republican support, but pulling the bill was a surprise that left people to ask, “What happens to health care reform now?”  

There are many ways for the Republican Party to move forward. The first is to continue to refine the AHCA until they are confident it could pass through the House, and then send the bill to the Senate to continue the reconciliation process. However, not long after the bill was pulled, both House Speaker Ryan and President Trump spoke to the press and indicated that Republicans would “move on” from health care reform for now and turn their attention to the next major agenda item: tax reform. 

But that leaves many wondering if full 'repeal and replace' of the Affordable Care Act (ACA) will still happen. It’s unlikely, at least for the time being, as Paul Ryan stated very clearly during his press conference that the ACA will be the law of the land for the foreseeable future. President Trump took things a step further by saying that he will wait for the ACA to “explode,” and then have Republicans approach Democrats to draft bipartisan replacement legislation. He didn’t provide details about what this bipartisan legislation would look like or what the ACA “exploding” really means, but at their core, these statements indicate repeal and replace is not going to happen anytime soon. 

Political maneuvering aside, there is a roadmap for tracking events related to the future of health care reform. The Republicans have been alluding to a “three-phase” plan for healthcare reform for many weeks, and the AHCA was simply part one. Parts two and three of their plan were never contingent on part one being fully executed, and it appears likely that next steps, at least in the short-term, would include acting on the other phases.

Phase two includes the Department of Health and Human Services (HHS) amending and eliminating ACA regulations, and in some instances dictating new policy via presidential executive orders. At this stage, we’re unsure of what regulations HHS will target, or what specific executive orders are being drafted, if any. This will be an important item to track, especially because these types of actions by HHS are subject to the Administrative Procedures Act, which can be a very time-consuming and lengthy process. Because of this, it’s unlikely that phase two will have immediate impact on anything. 

Phase three is the introduction of new legislation related to association health plans, medical tort reform, and cross-state insurance sales. Steps to implement phase three are already underway, and the following proposed bills are components:

  • The Competitive Health Insurance Reform Act (H.R. 372), which eliminates anti-trust protection for insurance providers and creates competition so Americans have multiple choices of health care coverage.
  • The Small Business Health Fairness Act (H.R. 1101), which allows small businesses to pool together and purchase plans, increasing their purchasing power to negotiate better care and lower premiums for their workers. This is an important step toward purchasing health care across state lines as it allows interstate shopping for small business plans.
  • The Protecting Access to Care Act (H.R. 1215), which prevents abusive lawsuits that cause higher premiums due to the high and unnecessary cost of defensive medicine.

So while total repeal and replace is not likely to take place any time soon, there is a path forward to reform of the current system in place. 

Long-term bipartisan legislation

President Trump and a few Republicans have already addressed the notion of longer-term bipartisan legislation that would comprehensively reform the ACA, or in essence replace it. President Trump addressed it very broadly on Friday after the AHCA was pulled from the House floor. Other Republicans, such as Senator Lindsey Graham of North Carolina, began discussing this possibility with their colleagues and constituents the next day.

This will be a slowly evolving and interesting conversation as leaders of the Democratic Party begin to join. While some legislators claim the ACA is “exploding,” there are others that strongly support the law and believe that a bit of reform could provide the relief that Americans are looking for, especially related to rising premiums. 

Uncertainty still clouds the long-term future of health care reform, but there are clear next steps Republicans will take. We will continue to monitor these actions as they occur and update you on the practical implications they present.