The “Exploding” Affordable Care Act? 

By Jill Zorn

hqdefault-e1490986662710.jpgWhen last we left Affordable Care Act (ACA) repeal, it was a runaway train hurtling down the track.  Then, last Friday, March 24, House Speaker Ryan and President Trump said they were giving up and walking away from their (Un)American Health Care Act, a bill that would have taken health care away from 24 million people.

Paul Ryan declared the ACA was the “law of the land…for the foreseeable future” and pulled the bill off the floor of the House.  Donald Trump said he was ready to move on to other issues, like tax reform.

Grassroots activist groups which have sprung all over the country since the November election, had a lot to do with this victory.

On March 24, activists breathed a sigh of relief allowed themselves to celebrate and enjoyed a much-deserved weekend off.

But that sense of relief has been short-lived as it has become evident that the repeal train has not quite been derailed.

Just yesterday, the Senate voted, with Vice President Pence breaking the tie, to allow states to withhold Title X family planning funding from Planned Parenthood.

As this vote indicates, Republicans are far from done with taking health care away from people.  In fact, the day after the bill was pulled, Trump was gleefully tweeting that the ACA will “explode.”

Fact checkers disagree with this pronouncement.  The Congressional Budget Office found that the health care marketplaces are stable in most states.

Still, we are left wondering if Trump is making a misguided prediction about an impending ACA explosion, or a veiled threat to “light the fuse.”

The fact is, the ACA is complex and requires a lot of care and feeding.  The Obama administration did its best to keep the law functioning, even in the face of active opposition from Congress.

Divisions among Republicans meant they failed to pass the American Health Care Act, and may not be able to revive it.  But now that the Republicans have control of both Congress and the White House, there are still many things they could do to undermine the law.

The most immediate threat involves a law suit about the ACA’s cost sharing reductions.  These are extra financial subsidies paid directly to insurers that help reduce copays and deductibles for lower income people who receive health coverage through the marketplace.  The House filed a lawsuit against these payments last year and the case is now tied up in court.  The Obama administration fought the law suit, but what will the Trump administration do?

So far, the new administration has continued to fund the subsidies and Congress is not getting in the way.  But whether Congress will actually pass legislation to keep the subsidies secure into the future is still an open question.  You can read more about this issue here.

This blog post from Ron Pollack of Families USA, lists other possible threats to the ACA due to administrative action or inaction, including,

  • Cutting funding for enrollment outreach and marketing
  • Refusing to enforce the individual mandate

So, what will they do?  On Wednesday, Tom Price, Trump’s Secretary of Health and Human Services and a known opponent of the ACA, “offered few hints” about the administration’s intentions.  Yet under intense questioning from Connecticut Congresswoman Rosa DeLauro, he made his feelings about the law quite plain, stating, “We believe that the current law has harmed many individuals.”

Clearly, we won a very real victory on March 24, when outright repeal was stopped.  But this is no time for advocates to kick back.  We have a long hard fight ahead of us to protect the care of millions of Americans.

But activists don’t only want to play defense. There are many ideas out there right now about how to repair the ACA and, even more exciting, move beyond it.  Future blogs will highlight some of those ideas.

Here are a few more articles about whether and how the Republicans could explode the ACA:

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