House Speaker Paul Ryan and his allies had what looked like the big gorilla of efforts to change the Affordable Care Act.
Now that the American Health Care Act bill appears to be dead, or, at least is doing a convincing job of playing dead, other ACA-change proposals are getting more attention.
Any would-be ACA changers who want to make some kind of health coverage available to consumers in the individual market in 2018 need to act quickly, because health insurers are supposed to be developing filings for 2018 products now.
Even carriers willing to overlook the reality that making a profit in the individual market has been difficult since January 2014 are having a hard time knowing how they can sell sustainable coverage in 2018 without knowing what the support programs, or basic market rules, might look like.
Here’s a look at four possible solutions that are now getting more attention.
Seema Verma, the new head of CMS, owned a company that trained Indiana’s HealthCare.gov navigators. (Photo: Senate Finance)
1. Ask Seema Verma
Tom Bulleit, a Washington-based partner at Ropes & Gray LLP, says in a written commentary about the cancellation of the AHCA bill vote that one obvious outcome could big a bigger role for the U.S. Department of Health and Human Services, and the new HHS secretary, Tom Price.
Price “may undertake larger administrative efforts to roll back Affordable Care Act rules,” Bulleit says.
One example, he says, is the ACA essential health benefits package, or requirement that an individual or small-group major medical plan cover at least about 60 percent of the actuarial value of a standardized benefits package that includes 10 types of benefits.
Many Republicans would like to eliminate the EHB package mandate.
“Instead of repealing the 10 essential health benefits, HHS could issue new rules narrowing their definition, which might do a better job of threading the needle between moderates and conservatives than the blunt instrument of outright repeal,” Bulleit says.
But Price is an orthopedic surgeon and a former member of the House, not someone who’s had much experience with public or private health insurance.
Seema Verma, the new administrator of the Centers for Medicare & Medicaid Services, the HHS arm directly in charge of ACA commercial health insurance programs, such as HealthCare.gov, is famous for being the woman who figured out how to build health reimbursement arrangements into Medicaid coverage for moderately low income adults.
She also owned a consulting firm that has worked closely with private insurers and actuarial firms for years, and her firm had the contract to train Indiana’s navigators how to enroll people in coverage through HealthCare.gov.
She’s also open to learning more about how the individual health insurance market is really working by, for example, talking to insurance agents and brokers: The Baton Rouge, Louisiana-based Health Agents for America reports that Verma’s office is trying to bring HAFA agents in for a meeting.
2. Repealing the Affordable Care Act
Crafters of the AHCA bill called it an ACA repeal effort, but it was really a piece of legislation designed mainly to change ACA budget provisions. The drafters wrote it that way because Republicans hold just 52 seats in the Senate, and a budget measure can get through the Senate with just 51 votes, rather than the 60 normally needed to push a bill onto the Senate floor.
But some members of Congress have already introduced true ACA repeal bills.
Rep. Steve King, R-Iowa, has introduced H.R. 175, the ObamaCare Repeal Act bill, which would simply repeal the Patient Protection and Affordable Care of 2010 and the health care provisions in the Health Care and Education Reconciliation Act of 2010.
Rep. Bill Flores, R-Texas, has introduced a slightly longer bill, H.R. 370. That bill would repeal PPACA and the health care portions of the HCERA, and it would exempt ACA repeal from the usual federal budget impact reduction requirements.
On the one hand: Those bills might do more to increase the number of uninsured people and drive up the federal budget deficit than the AHCA bill.
But, on the other hand: The simplicity of the bills might have some appeal for the many Republicans who truly want to repeal the ACA, not just change it. If ACA progams started doing poorly enough, it’s theoretically possible that some Democrats could warm up to the idea of simply eliminating the ACA and daring everyone to fill the vacuum.
Sen. Bernie Sanders, D-Vt., appears to be getting ready to reintroduce his single-payer health care system bill. (Photo: Sanders)
3. Covering everyone
Colorado voters were Democratic enough to give the state’s Electoral College votes to Hillary Clinton in November, and they sent Michael Bennet, a Democrat, back to the Senate.
But they killed a single-payer health care system bill by a vote of 79.4 percent to 20.6 percent.
The Colorado vote got little attention outside of Colorado, however, and Sen. Bernie Sanders, D-Vt., has been able to use his personal popularity to build support for the concept nationwide.
He has tweeted about health care often.
“Now more than ever we need to recognize that health care is a right,” Sanders tweeted today. “People who can’t afford health care don’t deserve to die.”
4. Crossing party lines
In Colorado, the state where a single-payer ballot measure crashed and burned, at least two Democrats have talked openly, and visibly, about the need for Democrats and Republicans to work together to improve the ACA.
Rep. Diana DeGette, D-Colo., gave an interview calling for bipartisan action to The New York Times.
Rep. Jared Polis, D-Colo., talked about the need for bipartisan action while the powerful House Rules Committee was getting the AHCA bill ready for its ill-fated trip toward the House floor.
Meanwhile, Sen. Susan Collins, R-Maine, and Sen. Bill Cassidy, D-La., are reminding everyone about an ACA change proposal, the Patient Freedom Act of 2017 bill, they released in 2017: their proposal would let each state choose whether to stick with the ACA framework or shift to a more flexible system.
“The PFA takes power from Washington and returns it to state capitols and individuals,” Cassidy says in a statement about the proposal.
Other veteran Republican senators, including Charles Grassley of Iowa and Lamar Alexander of Tennessee, are also pushing or a bipartisan solution.