Health Law Faces 5 Key Challenges As Republicans Switch Tactics : Shots

 In U.S.

Republicans in Congress say they haven’t given up on getting rid of the Affordable Care Act. They’re just switching tactics.

Katherine Streeter for NPR

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Katherine Streeter for NPR

Republicans in Congress say they haven’t given up on getting rid of the Affordable Care Act. They’re just switching tactics.

Katherine Streeter for NPR

Republicans officially pulled the plug on their last-ditch effort to repeal and replace the Affordable Care Act on Tuesday.

“We don’t have the votes,” said Sen. Bill Cassidy, R-La., after a closed-door meeting of Senate Republicans. “And since we don’t have the votes, we’ve made the decision to postpone the vote.” Cassidy, along with Sen. Lindsey Graham, R-S.C., put together the proposal they hoped could pass the Senate.

As of Sunday, though, the Senate will no longer be able to pass a health law overhaul bill with only a simple majority. That means the bill is effectively dead, for now.

That message was underscored by Senate Majority Leader Mitch McConnell, R-Ky., who said, “Where we go from here is tax reform.”

But that does not mean all is smooth sailing for the ACA. Here are five ongoing challenges the law faces.

1. Insurers still face tremendous uncertainty.

Wednesday is the deadline for health insurers to finalize rates for the 2018 individual market open enrollment season, which starts Nov. 1. Yet there has been no resolution to the question of whether the federal government will continue to reimburse insurers for subsidies known as cost-sharing reductions. Those are payments insurers are required to provide to moderate-income enrollees to help them afford deductibles and out-of-pocket costs. The law says the federal government is supposed to make those payments, but a lawsuit has left that an open question, and the Trump administration has repeatedly threatened to stop making the payments.

Without reimbursement of those subsidies, Pennsylvania Health and Human Services Secretary Teresa Miller told the Senate Finance Committee Monday, insurers in her state “reported they would need to request a statewide average increase of 20.3 percent” in the cost of health plan premiums. Those increases are similar nationwide.

A bipartisan effort led by Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., to advance legislation to affirmatively fund the payments was reportedly progressing until Republican leaders stopped them to concentrate on efforts to pass the Graham-Cassidy legislation.

But Alexander and Murray now appear back at it.

Murray said Tuesday she is “ready to keep working on the bipartisan path that could lead to results.”

Alexander similarly released a statement that he would “consult” with Murray and others “on a limited bipartisan plan that could be enacted into law to help lower premiums and make insurance available to the 18 million Americans in the individual market in 2018 and 2019.”

2. The Trump administration has cut funding for efforts to sign people up for insurance.

Administration officials announced earlier this month major cuts to the “navigator” program, which provides funding to community groups that guide people through the complex task of signing up for health insurance through the online marketplaces. Some groups are losing more than 90 percent of their budgets.

The cuts have forced many groups to lay off workers just before open enrollment begins and to limit the areas they serve.

3. The 2018 enrollment period is half the length of 2017’s, and now it will be shorter still.

Trump officials are also slashing by 90 percent the advertising budget that reminds people about open enrollment and how to sign up — from $100 million to $10 million.

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