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Medicaid expansion looks safe for now, but nothing else is certain

Health plans are pleased that, at least for now, the major gains in enrollment under Medicaid that the ACA facilitated will be left intact. Other than that, though, the uncertainty about the future leaves them unsettled after the latest attempt by the GOP to repeal and replace the ACA went down in flames, the Wall Street Journal reports.

“For insurers, the results are mixed,” the newspaper reports. “They fought to kill a provision in the latest Senate bill that they said would have blown up the ACA’s marketplaces, but they supported Republicans’ efforts to kill the law’s tax on health-insurance plans.”

President Trump’s tweet to “let Obamacare fail” isn’t exactly calming nerves. Insurers are particularly concerned that the federal subsidies that allowed them to sell affordable coverage to low-income people will dry up. Those subsidies would have continued next year and in 2019 under the failed Senate bill.

The WSJ: “‘If he wants to destroy Obamacare, all he has to do is stop’ the payments, said Jerry Dworak, chief executive of Montana Health Co-op, a nonprofit offering marketplace plans in Montana and Idaho. ‘That would probably end it right there. I don’t know if he’s bluffing.’”

In a statement, the Blue Cross Blue Shield Association said that “with open enrollment for 2018 only three months away, our members and all Americans need the certainty and security of knowing coverage will be available and affordable for them.” The Association backs moves by the states and federal governments to “stabilize insurance markets in the short term.”

Hospitals aren’t exactly thrilled with the latest developments either. Robin Wittenstein, CEO of hospital operator Denver Health, says that the collapse of the insurance market “would have a devastating effect.”

States are also scrambling. Some have seen insurers pull out of exchanges; some have seen insurers holding strong. As Mike Kreidler, Washington state’s insurance commissioner, puts it: “You can’t just sit back and wait for bad things to happen.”

Gary Cohen, a vice president at Blue Shield of California, tells the WSJ that the exchanges in his state have been relatively stable, but he knows that’s not the case everywhere. “We will see a difference in states. The Obama administration took a more rigid view and were less welcoming to those state initiatives than the Trump administration has indicated it will be.”