GOP set to shift tactics on ObamaCare in 2018

The politics surrounding ObamaCare will shift in 2018, with opponents and supporters of the health-care law expected to change tactics. 

With the GOP push to repeal ObamaCare possibly dead on arrival next year, conservative health-care experts say the White House and Republican Congress should focus instead on containing what they see as the law’s damage. 

“It might be time for Republicans to recalibrate, to think more in terms of containment, which is containing itself in terms of its future growth and spread, rather than some type of radical rollback,” said Tom Miller, a resident fellow at the conservative American Enterprise Institute think tank.

“Once things get institutionalized and planted in U.S. health policy for a number of years, regardless of whether they’re good or bad, they tend to stick around.”

Supporters of the law, in contrast, feel as if the Affordable Care Act has largely survived its first year in the face of a united GOP government committed to destroying it. They’re hoping for a good election year that could bolster the health-care law’s defenses going into 2019. 

“I think we continue to limp along, and my hope is that we get a Democratic House in November — and possibly a Democratic Senate, although that looks even harder — and then we start turning this ship around before it goes too much further aground,” said Timothy Jost, a Washington and Lee University professor emeritus and Obamacare supporter.

Earlier this year, Republicans spent months on a failed bid to repeal and replace ObamaCare, only to see the GOP Senate unable to corral enough votes to pass a bill. 

Come January, that task will be even harder, as Senate Republicans’ already razor-thin majority shrinks to one vote after Alabama Democrat Doug Jones is seated.

That’s a political reality Senate Majority Leader Mitch McConnell (R-Ky.) has acknowledged, signaling an intention to move away from ObamaCare repeal.

“Well, we obviously were unable to completely repeal and replace with a 52-48 Senate,” McConnell told NPR in late December. “We’ll have to take a look at what that looks like with a 51-49 Senate. But I think we’ll probably move on to other issues.”

That would leave ObamaCare the law of the land next year, but questions loom over what form it will take. 

This year, ObamaCare supporters charged the Trump administration with actively working to sabotage the law by cutting the window to enroll in coverage by half, slashing funding for advertising and more. They worry actions already underway could result in fewer Americans with health coverage and undermine the individual insurance markets. 

For instance, the Republican tax overhaul — which Trump has since signed into law — repealed the individual mandate beginning in 2019. The nonpartisan Congressional Budget Office estimated this would lead to a premium increase of about 10 percent and 13 million fewer Americans with health insurance by 2027, but insurance markets would “continue to be stable in almost all areas of the country.”

“There is lots of uncertainty over what the effect repeal of the individual [mandate] will have starting in 2019,” Larry Levitt, a Kaiser Family Foundation senior vice president, wrote in an email. “What matters most initially is what insurers believe the effect of repeal of the mandate will be, which will influence how much they increase premiums and whether they participate in the market at all.” 

In mid-October, Trump signed an executive order directing agencies to craft regulations aimed at easing ObamaCare’s rules. Proposed regulations haven’t yet been released, but the order targets lifting limits on short-term health plans and letting small businesses band together to buy health insurance.

Republicans say this move injects freedom of choice into the insurance markets and lets consumers buy cheaper plans. But ObamaCare supporters warn they could serve as administrative weapons against the health law.

“I think [the administration is] hearing from a lot of people that some of those things, like short-term policies and association health plans, could be very disruptive and could hurt a lot of people and drive the cost of insurance up, hurt the markets,” said Andy Slavitt, who served as the head of the Centers for Medicare and Medicaid Services (CMS) under former President Obama. 

In deciding to support the GOP tax bill, Sen. Susan Collins (R-Maine) received assurance GOP leadership would support her bill with Sen. Bill Nelson (D-Fla.). Collins would like $10 billion over two years to insurers to compensate them for the costs of covering sick and expensive enrollees.

ObamaCare proponents view this as helpful to the law. Though Slavitt would like to see permanent funding, he called the measure a step in “the right direction.”

Additionally, the Trump administration could seek to grant states more flexibility in tailoring their health programs. Some states are already awaiting approval from CMS to implement changes to their Medicaid programs that would allow for conservative measures, such as work requirements, for the first time.

Experts from across the political spectrum noted growing expenses for higher earners who buy coverage in the ObamaCare health marketplaces.

The majority of consumers who purchase plans in the exchanges are essentially immune to premium hikes because they receive financial help from the government to pay for their plans. But those who make more than 400 percent of the poverty level are saddled with paying the extra cost. 

“What’s happening now is the focus has shifted to are there ways to bring down the cost for the people who are getting hit with it — not so much the subsidized people, the unsubsidized,” said Edmund Haislmaier, a senior research fellow at the conservative Heritage Foundation think tank.

“There will be a lot of that going on involving the state and the administration, I think, next year,” he said.

Haislmaier, like other conservative health-care experts, said he views the individual marketplaces as remaining fairly stagnant in terms of the number of people who sign up for plans. A similar number of people — roughly 8.7 million — signed up for ObamaCare plans this year, compared to last year’s 9.2 million enrollees. 

“Its natural equilibrium state is a subsidized population of lower income, but not Medicaid, individuals with health conditions ranging from modest to severe,” Haislmaier said, “And that’s what this market attracts, and that’s what it’s going to continue to attract. As long as those people are being subsidized, they’re not going to go away.”