ObamaCare gets new lease on life

ObamaCare has a new lease on life after House Republicans abruptly pulled their bill to repeal the law and said they are moving on to other issues.

It was a striking reversal of fortune for the healthcare reform law, which Republicans have been vowing to repeal ever since it passed.

Now, suddenly, Republicans appear resigned to the law staying in place after proving unable to repeal and replace it when the moment came.

{mosads}“We tried. We tried our hardest,” said Rep. Michael Burgess (R-Texas), chairman House Energy and Commerce subcommittee on health. “There were people who were not interesting in solving the problem. They won today. The Freedom Caucus wins. They get ObamaCare forever.”

Speaker Paul Ryan (R-Wis.) acknowledged at a press conference that “we’re going to be living with ObamaCare for the foreseeable future.”

“ObamaCare is the law of the land,” Ryan added, repeating a phrase stated by former Speaker John Boehner (R-Ohio) after President Obama’s reelection victory in 2012.

Boehner had to walk back his words, but it’s not clear Ryan will be forced to do so.

Ryan and President Trump both said that they still think ObamaCare will collapse on its own.

“I really believe that ObamaCare is a law that is collapsing,” Ryan said. Trump said that ObamaCare “will explode” and expressed hopes that Democrats will be forced to deal with him.

The president suggested a bipartisan deal, something Democrats have long expressed openness to if Republicans would drop the repeal effort, might be possible.

“I think that’s going to happen,” Trump said Friday of a bipartisan deal on healthcare, adding, “I’d be totally open to it.”

Democrats were already releasing statements on Friday that signaled their willingness to work with Republicans to improve healthcare.

While the law has its challenges, many experts strongly dispute the idea that it will collapse on its own. Enrollment remains relatively steady, while dropping a little for 2017, despite all the talk of repealing the law.

Before the November elections, the main problem facing the law was that some insurers were dropping out because of financial losses from enrollees who were sicker and costlier than expected.

Those problems are still around, though a report from Standard & Poor’s Financial Services in December found that the situation was improving and that large premium increases for 2017 were a “one-time pricing correction.”

The nonpartisan Congressional Budget Office noted in its analysis released last week that the individual market would “probably be stable in most areas” under current law.

It is possible that insurers might not offer ObamaCare coverage at all in a handful of counties, something that nearly happened in one Arizona county last year. The Obama administration helped make regulatory fixes and worked to encourage insurers to stay in the markets, which the Trump administration might not do.

With the repeal effort abandoned, one of the biggest questions on healthcare is how the Trump administration will handle overseeing a law that it opposes. 

Larry Levitt, a healthcare policy analyst at the Kaiser Family Foundation, said that the “Trump Administration has plenty of options to facilitate the collapse of the ACA marketplaces if they wanted to.”

He noted that on its own, the administration has broad authority to stop enforcing ObamaCare’s individual mandate, which could destabilize the market. 

The administration could also cancel ObamaCare payments known as “cost sharing reductions,” which reimburse insurers for giving discounts to low-income people, but that Republicans have argued are being paid out illegally without congressional authorization. Insurers could bolt from the market without those payments.  

The administration, though, might not want to cause chaos in the health system by taking steps to undermine the law.

Andy Slavitt, who oversaw ObamaCare as head of the Centers for Medicare and Medicaid Services under President Obama, said in an interview that Trump “will be judged quite harshly if he doesn’t properly steward the law.”

He said that if Republicans work with Democrats there is a “terrific opportunity” to improve the law. He pointed to a waiver process under the law to allow states to make changes and innovate on their own, providing funding to help bring down premiums on a state level through a system known as “reinsurance,” and even the possibility that states could enact their own public options to increase competition.

“If you parse through the words, you can kind of view it as an invitation to bipartisanship,” Slavitt said of Trump’s comments Friday. 

Still, Republicans on Friday said work could still be done on the GOP’s second and third phases of the repeal, which involve regulatory reforms through the Health and Human Services Department and other legislation.

“We keep going. This process doesn’t end just because this one bill has been taken off the table for some period of time,” said Rep. Bradley Byrne (R-Ala.).

But, he added, Republicans will have to act eventually to make reforms to the exchanges, where insurers are dropping out and leaving many counties with few options.

“When the American people start losing their insurance on their exchanges, when the American people start having problems with their premiums and their deductibles, the pressure is just going to rise on us to do something,” he said.

Ryan acknowledged that “there are some things” Health and Human Services Secretary Tom Price can do to “stabilize things,” but “we do lose a lot of the tools we wanted to help improve people’s lives and bring down healthcare costs in this country.”

Republicans should just head back to the drawing board, said Rep. Justin Amash (R-Mich.), a member of the Freedom Caucus.

“We need to start from the beginning and make sure all of the concerns are addressed,” he said. “From the beginning of the process, I think that the way it was set up did not bring the disparate parts of the conference together.”

– This story was updated at 6:32 p.m.