Insurers are out of the fire — and bracing to fall into another one.
Shares of insurance companies with Obamacare exposure rallied Tuesday on news the Senate will not vote on the Graham-Cassidy bill, the GOP’s latest effort to repeal the Affordable Care Act (ACA).
But the rally has been small, likely reflecting the fact that the measure’s chances of passage were always fairly slim — and the GOP may not give up on this effort even after another bruising defeat.
Graham-Cassidy was a hastily written and poorly conceived bill that likely would have disrupted insurance markets and left millions of Americans uninsured. Insurers are better off with it dead.
But the fact that the GOP even tried this again after several embarrassing failures — without addressing the political and policy difficulties that caused them — shows how intense the pressure to repeal the ACA remains. That’s not going away.
And the GOP can still write a new budget resolution that gives them another shot at passing a health-care bill with a simple majority. We could very well go through this all over again soon; President Trump claimed Wednesday he had the votes to get a health-care bill done and that Congress will return to the issue early next year.
Related: Study says ACA market is stabilizing
Even in failure, the push for Graham-Cassidy has hurt the insurance market, by derailing a bipartisan effort to stabilize the ACA exchanges.
By the end of Wednesday, insurers must tell most states whether they’ll participate in the exchanges next year. There are rumblings that congressional stabilization work may start again, but it seems unlikely to succeed at all, let alone in time to have a large impact on the market in 2018. This uncertainty will likely mean lower insurer participation and higher premiums than if a stabilization bill had gotten a real shot.
And that may lead to lower enrollment in the individual insurance market, according to the Congressional Budget Office.
The Trump administration isn’t helping. It has slashed funding for advertising the exchanges and for paying the professionals that help people navigate the market and get insurance. It cut the enrollment period for buying insurance on the exchanges in half, and it’s shutting down the website people use to enroll for all but one Sunday during the enrollment period. Those people who will be most motivated to sign up in spite of these constraints are more likely to be sick, creating a worse risk pool for insurers.
The CBO has substantially cut Obamacare coverage estimates in part due to uncertainty sparked by administration actions and repeal efforts.
That may lead to financial difficulties for insurers that still have a heavy presence in the individual insurance market, even if they charge higher premiums. And Republicans may well seize on the turmoil they have created as evidence the ACA needs to be repealed.
Insurers that have already pulled back from the ACA aren’t immune; just about every major effort to repeal the law has been coupled with huge cuts to Medicaid.
As much as insurers would like to relax after a seven-month roller-coaster ride of repeal efforts, their misery may only just be beginning.