What’s next for the Affordable Care Act? The ACA has survived being repealed and replaced because House Republicans could not agree on how to do that. Threading the needle with a bill that would repeal enough to satisfy conservatives and replace enough to satisfy moderates proved too big a challenge in the face of united Democratic opposition. The President said to vote on the bill or move on. The House leadership didn’t vote on it, but didn’t exactly move on either. Negotiations among Republicans have continued but no path forward has been found. It is also very likely that a bill conservative enough to pass the House would find significant opposition among Senate Republicans, and if three of them vote no, a repeal/replace bill will not pass in the Senate.
Obamacare is far from out of the woods. There are several steps the White House could take to weaken it just when insurance companies must decide if they will participate next year. If the Administration decides not to continue to fight a lawsuit over $7 billion in funding that goes to insurance companies to help cover the costs of insuring low income Americans, that money would very likely disappear and the insurance companies would be that much more likely to walk away from the program. There is a May court deadline for a status update on the case. Without the insurers’ participation, it doesn’t make much difference what happens to the ACA on Capitol Hill. Another way for the Administration to weaken the program is to stop enforcing the individual mandate which keeps many younger, healthier people participating. The Administration has not signaled its intentions about whether to proactively weaken the ACA. The insurers have until late June in most states to decide whether or not to sign up for another year. A significant portion of the country is down to only one participating ACA insurer as it is.
The other upcoming deadline that will help determine the future of the ACA is April 28, when Congress has to pass a spending bill that keeps the entire federal government funded through September 30. The most popular approach is a Continuing Resolution that simply says the government will keep spending the same amounts through September that it spent last year. There will however have to be some adjustments in areas such as defense, but the fewer changes, the more likely the spending bill will be to pass. A Republican Congress adding money to the bill to prop up Obamacare would not have seemed likely going into the year, but the White House and the Congress must decide whether to take steps that will keep the program alive another year, or take steps that will encourage the insurers to leave. There are political consequences either way. Two key House Members have indicated they are open to adding the $7 billion that may be lost in the court case, but others would have a difficult time supporting $7 billion for a program they have so often tried to eliminate.
The House Leadership hoped to pass a bill before the two-week Easter recess when House members are back home in their districts but that has not happened. Members will undoubtedly hear from constituents about their vision of the government’s role in making healthcare affordable and available for millions of Americans. That could well have an effect on the decisions that have to be made back in Washington in the very near future.