Healthcare News & Insights

Senate debates ACA repeal: Latest developments for hospitals

The roller coaster ride that’s the Affordable Care Act (ACA) repeal continues. After several different attempts at repeal failed to advance, the Senate finally got enough support to bring an actual ACA repeal discussion to the table. But for hospitals and other healthcare stakeholders, the path from here remains unclear. 

With a narrow majority (using Vice President Mike Pence as the tie breaker), the Senate voted to start debating the ACA as the first major step toward a repeal, according to an article in the New York Times.

At first, reps were pushing the approval of the Better Care Reconciliation Act – the latest version of an ACA replacement bill passed by the House.

Because of several provisions of the law, including the removal of the individual mandate to have health insurance and an amendment that would allow payors to offer plans that didn’t cover the ACA’s “essential benefits” or pre-existing conditions, it didn’t gain much support the first time around.

And in the latest ACA repeal debate, it again failed to earn enough votes to advance.

The Senate’s just rejected another bill that would allow an ACA repeal without any sort immediate replacement planned for two years – a tactic that was discussed by the House previously, but was voted down because it would’ve hurt millions of people.

This bill would’ve phased out federal subsidies and ended Medicaid expansion by 2020. It would’ve also gotten rid of taxes on payors, medical device makers and wealthy citizens, among others. The Congressional Budget Office’s (CBO) analysis of the legislation estimated that this approach would leave approximately 32 million people without insurance coverage by 2026.

The Senate vote against the measure was 55-45, with seven Republicans joining all Democrats to reject the approach.

Different approaches

Other options are still on the table. Per an article from ABC News, the Senate is also considering what it’s calling a “skinny repeal,” where it removes some the more controversial portions of the ACA (such as the individual mandate and taxes on medical device makers), but keeps others.

The full text of this legislation hasn’t been released yet, but according to an article from CNN, a similar bill evaluated by the CBO would leave 16 million people uninsured over the next decade – and would cause premiums to rise by 20%.

In addition, Congress could re-introduce a stripped-down version of the Better Care Reconciliation Act, which the CBO estimated would cause 22 million people to lose insurance coverage by 2026.

Most of these options are still causing controversy in health care, with groups such as the American Medical Association opposing the Republicans’ plan to remove the individual mandate to have insurance. Because healthy people won’t be required to have insurance, prices will rise for all, the organization said in the ABC News article.

And that’ll inevitably increase the number of uninsured patients seeking care at hospitals for various unexpected acute health issues. Bad debt, which had decreased with the expansion of Medicaid under the ACA, will likely skyrocket. And many other ripple effects will be felt in hospitals’ budgets.

Even major payors, such as Blue Cross Blue Shield, have come out and said the current proposals are dangerous – especially if subsidies are abolished. Losing funding to provide coverage to low-income patients will cause many payors to offer fewer plans to them.

The face of the ACA repeal keeps changing, and nothing’s been decided yet. We’ll keep you posted.

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