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AHCA has failed – what’s the next step?

AHCA has failed, and with it the Republicans’ efforts to repeal ACA.

Despite President Trump’s threats, cajolery, and bribing the Freedom Caucus, the attempt to repeal ACA is, for now and probably for the long term, dead.

(Please allow me this opportunity to point out that I predicted three months ago that ACA would NOT be repealed)…OK, chest pounding interlude is over…

What does the future hold?  While we all wish Congress would adopt sensible solutions to fix ACA, that’s highly unlikely. Steps such as

  • increasing the penalty for not carrying insurance to levels originally recommended by the Heritage Foundation,
  • fully funding the risk corridors and co-op support measures
  • fixing the “family glitch”
  • require insurers to operate in broad areas so they don’t cherry-pick only the most profitable locations, and
  • requiring full transparency from all medical providers

would help a lot, and that’s not even adding a Medicare-for-all option. As I noted in a previous post, Democrats helped fix G W Bush and the GOP’s Medicare Part D plan when it was cratering.

Unfortunately, it’s more likely the administration will do everything it can to hamstring ACA – refuse to enforce the mandate, end premium support, defund the federal Exchanges, you name it.  In the process, they’ll likely blame the prior president, or Democrats, or whatever. And in so doing, they will hurt businesses, taxpayers, individuals, patients.

What’s most likely is a concerted and persistent effort to defund Medicaid.  This will be described as allowing states more flexibility, as refusing to use federal funds for abortions, as reducing the federal deficit, but make no mistake, the real priority is to shrink funding for the poor, elderly, kids, and disabled.

Lest you think that’s harsh, recall that those are precisely the people Medicaid helps.  It remains to be seen if Republicans will be successful, or if they will come together and heal the fractures so visible within the party.  If they do, they will likely find Democrats willing to work with them, perhaps using the Cassidy Collins bill as a starting point.

There’s been a lot of energy focused on blocking or passing AHCA.  Let’s take a few days to let the smoke clear, and then try to get Congress to work together to fix ACA.

Because it isn’t going to be repealed.

4 thoughts on “AHCA has failed – what’s the next step?”

  1. They haven’t tried everything, according to Churchill. They haven’t tried Medicare for All, which would solve everyone’s problem, keep 24 million alive, and be much cheaper in the long run. But ideologically speaking, that won’t happen until the GOP is DOA.

  2. This is a happy day! Wooohoooo!

    If Republicans really wanted to lower costs, democrats would work with them. But, this was so blatantly an effort to pull the rug out from the poor and sick to give the richest 1% a tax break. And this is supposed to be country of religion and morals? What is moralistic about cutting healthcare for millions of people? This was a good day, but the fight continues. This president is one bad hombre.

  3. $20 trillion in debt and a $30 trillion actuarial problem in Medicare and people are cheering. Absurd.

    1. Hello Michael, welcome to MCM. One reason for the cheers is the bill would have done nothing to address long term deficits, and eliminating the taxes would have led to an even larger actuarial problem for Medicare. Cutting taxes on the wealthiest and those entities that have benefited the most from coverage expansion would have been a major contributor to the debt and deficit problem.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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