Health Care Reform Proves Challenging for Lawmakers

The Affordable Care Act (ACA) was signed into law on March 23, 2010, by then President Barack Obama. Provisions were included that required individuals to have insurance, allowed young adults to remain covered under their parents’ plan until age 26, and protected patients with preexisting conditions, and for the first time, prescription drug coverage was deemed an essential health benefit.

This last item was especially favorable for the pharmaceutical industry, according to the session TrumpCare: What Now? presented at the Asembia Specialty Pharmacy Summit 2017. The ACA allows states to increase their Medicaid coverage to more Americans by lowering the financial threshold. To date, 32 states have expanded their Medicaid programs, which collectively insure 14.5 million Americans.

During his 2017 election campaign, President Donald Trump promised to repeal certain provisions of the ACA, lower premiums, expand the use of health savings accounts, and increase price transparency. Specifically for pharmacy, he expressed support for importing prescription drugs and allowing Medicare to negotiate drug costs, according to the session. Almost immediately after Trump took office, GOP lawmakers drafted the first version of the American Health Care Act (AHCA), which was introduced in March 2017.

“This was aimed at getting to the conservatives’ concern that the ACA was leading to higher insurance premiums and costs because of all of the mandates,” said panelist Paul Kelly, principal, The Federal Group.

The AHCA seeks to repeal multiple provisions of the ACA, including the individual and employer mandates. Under the law, subsidies for individual insurance would not be offered, taxes for manufacturers and insurers would be repealed, Medicaid expansion would be reversed, and Medicaid would receive block grant funding. States would also be able to offer alternative benefits instead of the ACA’s 10 essential health benefits, according to the session.

The Congressional Budget Office revealed that the AHCA would result in 14 million fewer individuals insured by 2018, although it would keep several aspects of the law. GOP leaders realized that they did not have enough party support for the first version of the AHCA and it was subsequently pulled from consideration.

Despite this setback, Republican leaders continued to work on the bill and the revised version was subsequently passed by the House on May 4, 2017 (after this session was held), by a vote of 217 to 213. This updated AHCA allows states to apply for waivers to not participate in certain ACA mandates.

As a result of this change, the bill gained the support of the conservative House Freedom Caucus. Interestingly, while some conservative lawmakers are withholding support because they feel the bill does not do enough to repeal the ACA, moderates feel the bill repeals too much, according to the session.

Although the AHCA narrowly passed, the next major hurdle is getting the bill through the Senate without substantial revisions, which is notoriously difficult to do. In the meantime, also mentioned during the session, there are things that the Trump administration has done to nullify the ACA without Congressional action. Trump has said that the ACA will implode due to insurer withdrawal from the insurance exchanges and he can continue to develop executive orders that undermine the ACA.

“They [Republicans] have had a series of votes to repeal and replace the ACA in the House, but they knew Obama would veto them,” Kelly said. “Now they are trying to figure out what to do about it [the ACA] and they are finding out that it is difficult, it is complicated, and it is not going to happen easily.”