The healthcare industry is starting to line up with wish lists as the GOP-led Congress and the Trump transition team work on their Obamacare strategy.
Insurers, drug makers, device makers, doctors, hospitals and states will be piling on the pressure as the newly elected Congress returns next month to a laundry list of projects topped by repealing the healthcare law. The ground is primed for an intense industry lobbying effort, as Republican lawmakers consider a range of different approaches for repealing the Affordable Care Act and replacing it with their own reform plan.
Republicans have said they intend to use special budgeting rules to repeal the law and provide a transition period so people don’t immediately lose coverage. But House Speaker Paul Ryan, who will guide the effort, has remained vague about details beyond that.
“We want to make sure that we have a good transition period, so that people can get better coverage at a better price,” Ryan told “60 Minutes” last week, but he said he doesn’t know the answer to how long the transition period will be or specifics about a replacement plan.
The healthcare industry was involved when Congress wrote and passed the healthcare law six years ago. In exchange for getting more insured patients able to pay for their care, insurers, providers and pharmaceutical companies agreed to pay new taxes and give up some federal payments to fund the sweeping healthcare law.
Now each sector is worried that lawmakers won’t keep their interests in mind in seeking a replacement to the law Republicans have vowed for so long to repeal.
America’s Health Insurance Plans, the leading association of health insurers, has assembled a memo with dozens of requests for Congress and the White House, which involve ditching the law’s insurance taxes but maintaining financial assistance to help people buy plans.
The group’s priorities include maintaining “reinsurance” payments to help insurers with more expensive patients, eliminating the Health Insurance Tax (known as HIT) and giving insurers more time to file 2018 rates.
“Today there are many more questions than answers, from timing and sequencing to what stays and what goes,” according to the memo, provided to the Washington Examiner. “What is clear is that the foundation of an effective individual insurance market is continuous coverage for everyone.”
Hospitals are concerned that their extra Medicare and Medicaid payments won’t be restored even if the number of uninsured Americans spikes again. The Affordable Care Act cuts extra payments to hospitals that serve a large low-income population, with the idea that more of those patients would now have coverage.
“If coverage recedes, to not restore that money in the hospital payments is to leave hospitals without sufficient money to cover the cost of the uninsured,” said Chip Kahn, president of the Federation of American Hospitals.
The group and the Americans Hospital Association wrote to President-elect Trump and congressional leaders on Tuesday, asking them to restore the payments in an Obamacare repeal bill.
“Restoring these cuts for the future is absolutely essential to enable hospitals and health systems to provide the care that the patients and communities we serve both expect and deserve,” the groups wrote.
The Pharmaceutical Research and Manufacturers of America, while less directly vested in the Affordable Care Act than insurers, is similarly urging Congress to avoid a scenario in which millions of Americans lose their coverage.
“Ensuring patients have access to the medicines they need is our top priority,” said PhRMA spokeswoman Ally Funk. “Even though more Americans have health coverage, patients continue to face real challenges accessing the care they need.”
And those invested in state Medicaid programs are fearful Republicans will roll back the healthcare law’s Medicaid expansion, which could cost states billions of federal dollars. That’s the worst-case scenario, says Matt Salo, executive director of the National Association of Medicaid Directors.
Salo is hopeful that instead, Republicans will expand the uses of a waiver in the healthcare law allowing states more flexibility in how to run their expanded Medicaid programs. Several Republican governors, including Vice President-elect and Indiana Gov. Mike Pence, have taken more conservative approaches to Medicaid expansion through that means.
“At the end of the day, people want to have coverage,” Salo said. “Exactly what it looks like is not necessarily the most important thing.”
In addition to all those groups, Republicans could face some pressure to work with Democrats. While Democrats pushed through the Affordable Care Act in 2010 without any help from the GOP, Republicans could gather broader public support for an Obamacare replacement if it’s bipartisan.
Democrats are emphatically opposed to repealing the healthcare law, especially if Republicans don’t immediately replace it. But there could be some room for bipartisan discussions down the road, as GOP members craft a replacement plan. The key to Democratic cooperation likely will be whether a Republican plan covers as many people as Obamacare.
“I think the bottom line for Democrats is that we don’t reduce the number of people who are covered,” said Tim Jost, a health law professor at Washington and Lee University and supporter of the healthcare law. “That we continue to take care of people who can’t afford coverage and that we continue to offer people coverage that isn’t junk.”
