The Republicans”™ first attempt at repealing and replacing the Affordable Care Act, or Obamacare, flat-lined. So what”™s next for health care?
That was the subject of a presentation to a group of business and hospital executives hosted by the Westchester County Association on April 5.
“People are asking the question, well what the hell happened?” said Kevin Dahill, president and CEO of The Suburban Hospital Alliance of New York State. “They were so resolute on saying they were going to repeal and replace ”” what happened?”
Dahill cited factions within the Republican Party, such as moderates and the more conservative House Freedom Caucus, struggling to reach a consensus. Ultimately negotiations between House Speaker Paul Ryan, President Donald Trump and the Freedom Caucus came to an end and Trump asked Ryan to bring the bill to a floor vote. Shortly after, Ryan told Trump he didn”™t have the votes and the bill was pulled.
“It was because of the fractured nature and that there were groups, particularly the Freedom Caucus, that thought they could get more than what they were getting,” Dahill said.
For now, the Affordable Care Act remains in effect.
“I”™m not here suggesting that the Affordable Care Act was Shangri-La by any stretch of the imagination” Dahill said.
He pointed to the collapse of Health Republic Insurance of New York, a nonprofit health insurance co-op created under the Affordable Care Act that shut down in 2015. There were 18 similar co-ops around the country, Dahill said, 14 of which have gone bankrupt.
The individual mandate also did not keep premiums under control as was hoped. Dahill said that was due to a fundamental flaw: the penalty for not having coverage wasn”™t enough.
“The notion was, we”™re going to make for a relatively healthy risk pool because we will bring in all the young invincibles and that will make it easier for the insurance companies from a risk point of view,” Dahill said. “Well, the fact is the penalties were relatively modest, so the young invincibles said to hell with it, I”™ll just pay the penalty once a year. It”™s cheaper than paying the premiums.”
On April 2, reports surfaced that Republicans were trying to revive talks for a bill to replace Obamacare. With Congress is set to break for a recess on April 7, getting a bill reviewed and to the floor for a vote by the House of Representatives before then would be difficult, Dahill said.
If House Republicans can unite all factions, they will have enough vote to get a replacement bill through. But it could take a balancing act to get there.
“If they give more concessions to the Freedom Caucus, in my opinion, they stand to lose a few more moderates and they could be back to a problem again,” Dahill said.
Among issues to watch for the replacement bill: What will happen to the Medicaid expansion?
The Affordable Care Act expanded Medicaid to 1.9 million people in New York. Dahill said the fate of federal dollars that help fund Medicaid should matter, even to people who run businesses or have coverage through an employer.
“If you do business in the state of New York, you should care because what would New York state do if this ever happens?” Dahill said. “New York is not going to walk away from the Medicaid program, politically it”™s just not going to happen. So there is going to be a big gap and what are they going to do? They are going to think about either cutting providers or raising taxes.”
