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September 27, 2017

Hospitals and lawmakers give their take after GOP abandons ACA repeal vote

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Senate Republicans on Tuesday abandoned the vote on their latest Affordable Care Act (ACA) repeal bill (HR 1628), leaving uncertainty about how—and whether—GOP leaders will move forward on health reform and how the Trump administration will approach the upcoming open enrollment period, the Washington Post's "PowerPost" reports. 

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Open enrollment for the 2018 coverage year is set to begin Nov. 1, and insurers face a Wednesday deadline to finalize premium rate changes and sign contracts to sell health plans on the exchanges. Given the uncertainty surrounding the ACA's future and, particularly, whether the Trump administration will make future cost-sharing reduction payments to insurers, many insurers have proposed steep premium rate hikes, while others have opted to leave or scale back exchange offerings, "PowerPost" reports.

Tabling ACA repeal, for now

Senate GOP leaders signaled Tuesday afternoon that they were not done with health reform, but they said that for now they would move on to other GOP priorities, such as tax reform.

Senate Majority Leader Mitch McConnell (R-Ky.) said, "We haven't given up on changing the American health care system." But he added, "We plan to move forward on our next priority, which is reforming the American tax code in significant ways for the first time in 30 years."

Sen. Lindsey Graham (R-S.C.), co-sponsor of the latest ACA repeal bill, said, "It took 18 months to pass Obamacare; it's going to take a while to repeal it. We had 50 votes for the substance, not 50 votes for process." He added, "With a new process, with more hearings, with regular order ... we're going to get 50 votes."

Some Republican lawmakers, including Sen. Rand Paul (R-Ky.) and Rep. Chris Collins (R-N.Y.), have suggested they could include language in the 2018 fiscal year budget reconciliation bill allowing both an ACA repeal bill and a tax reform bill to pass without a filibuster.

But several prominent Republicans on Tuesday rejected that idea, which the Wall Street Journal reported likely would for procedural reasons require Republicans to make smaller tax cuts than they have planned.

Senate Finance Committee Chair Orrin Hatch (R-Utah) said, "It would screw up the budget." And Senate Majority Whip John Cornyn (R-Texas) said, "I think we should give health care our shot and then move on to taxes. I don't think we should mix those up."

Rep. Mark Meadows (R-N.C.)—chair of the conservative House Freedom Caucus—similarly said, "If it has the potential of sinking tax reform, I wouldn't be in favor of adding it."

Bipartisan talks resume

In the meantime, Republican lawmakers appear split on whether or not they should act now to improve the exchanges.

According to "PowerPost," many insurers have waited in the hopes Congress would pass bipartisan legislation that would guarantee the CSR payments and improve the exchange market. Kristine Grow, a spokesperson for America's Health Insurance Plans, said many AHIP members "are waiting until the very last moment to make these decisions."

Senate Health, Education, Labor, and Pensions Committee Chair Lamar Alexander (R-Tenn.), said Tuesday he was open to resuming talks on a bipartisan bill that was tabled amid the latest drive to pass the Graham-Cassidy bill. "I'm still concerned about the next two years, and Congress has an opportunity to slow down premium increases in 2018, begin to lower them in 2019, and do our best to make sure there are no counties where people have zero options to buy health insurance," Alexander said in a statement. He said he would talk with Sen. Patty Murray (D-Wash.) and other lawmakers to see if they "can find consensus on a limited bipartisan plan."

Murrary also signaled a willingness to reopen disucssions, saying, "Let's pick back up right where we left off, and let's do it right now."

However, some GOP lawmakers—such as Cornyn and Graham—have suggested the ACA is beyond repair. Graham said, "I cannot tell you that I believe there’s any way to fix Obamacare. I think it’s beyond being repaired." Further, according to "PowerPost," House aides have said they do not believe the House would pass a bill that continues the ACA's subsidies.

Hospitals, hospital groups push for bipartisan bill  

Following the canceled vote on Graham-Cassidy, health care industry groups urged lawmakers to cooperate on future reform efforts.

The American Hospital Association in a statement said, "[I]t is our hope that leaders from across the aisle will start to work together for the benefit of patients across America."

America's Essential Hospitals in a statement said it was "thankful" Senate GOP leaders "chose to stop the rush to a vote on the Graham-Cassidy-Heller-Johnson proposal," adding, "We hope the Senate's decision today opens the door to renewed bipartisan talks on ways to fix the Affordable Care Act." 

Kaiser Permanente CEO Bernard Tyson said, "I believe strongly that if the government solves a few vital areas, insurers who got out of the market will get back into the market." Tyson said he favored giving states more flexibility in their health care decisions, but added, "There have got to be, in my view, some guidelines so everyone is clear about the threshold requirements across the country."

Steven Shapiro, an executive vice president at UPMC, similarly warned, "Absent some sort of bipartisan solution, health care will be a yo-yo in every election." He added, "We need some stability" (Eilperin, "PowerPost," Washington Post, 9/26; Snell/Weigel, "PowerPost," Washington Post, 9/26; Peterson/Armour, Wall Street Journal, 9/26; Wilde Mathews/Evans, Wall Street Journal, 9/26; Hellman, The Hill, 9/26; Min Kim et al., Politico, 9/26; Frieden, MedPage Today, 9/26; Alonso-Zaldivar, AP/Sacramento Bee, 9/27; Fulton, "Shots," NPR, 9/27).

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