2018 Year in Preview

ACA Repeal

Headed for a whimper, not a bang?

Robert Calandra

A year ago you probably couldn’t find a Las Vegas bookmaker willing to give odds that the ACA would still be the law of the land in 2018.

In gamblerspeak, it was off the board. With control of both houses of Congress and the presidency, the GOP could finally make good on their seven-year promise to repeal and replace President Barack Obama’s signature health care legislation.

Turns out, repealing the ACA and crafting a replacement acceptable to the party’s disparate factions isn’t so easy. Who knew health care—and health care politics—would be so complicated?

Republicans did come close. In July party leaders tried to get a slimmed-down repeal and replace bill through the Senate. But Republican Sen. John McCain of Arizona, recovering from brain surgery, scuttled that gambit, not just casting the decisive no vote but flashing a thumbs down for emphasis.

Meanwhile, President Trump declared the ACA “dead” and saying “there is no such thing as Obamacare anymore.” The administration slashed marketing and other funds for programs designed to boost enrollment in ACA exchange plans and cut cost-sharing reduction payments.

Kaiser Health Tracking Poll: The public’s views on the ACA

Source: Kaiser Family Foundation

As we went to press, it was uncertain how enrollment for ACA coverage in 2018 would play out. Early on, though, the number of signups was high.

Meanwhile, a fog of uncertainty also engulfed the compromise legislation negotiated by Sen. Lamar Alexander, a Tennessee Republican, and Patty Murray, a Washington Democrat. Virtually every description of that bill described it as “propping up” the ACA for a couple of years. And it would, in fact, fund the cost-sharing reduction payments for two years and put some money back into consumer outreach. In a bid to get Republican support, the legislation would make it easier for states to get ACA waivers and create so-called copper plans with low premiums and high deductibles (essentially, catastrophic insurance).

But by November, Washington’s attention shifted to the Republican’s tax reform proposal. Tax reform and ACA repeal did start to blend because some Republicans proposed including a repeal of the ACA individual mandate in the tax reform plan. Then Democratic victories in the November 6 election took the wind out of Republicans’ tattered sails and made some wonder if they would let the push to repeal the ACA fade away in 2018 after all the near-misses in 2017.

Some readings of the public opinion polls suggest that a whimper of an ending, not a banging one, might be the prudent course for the GOP’s repeal and replace urges (although prudence is definitely part of the Trump political appeal). According to an average of polls calculated by Real Clear Politics, more Americans have had an unfavorable opinion of the ACA than a favorable one since it was signed into law—until mid-January of this year when the ratio flipped. The trend toward a favorable opinion inched along through this year. By the end of October, Real Clear Politics’ poll averages showed that 51% of Americans have a favorable opinion of the ACA compared with 39% with an unfavorable one.

A blueprint for high-volume, high-quality lung cancer screening that is detecting cancer earlier—and helping to save lives

Clinical Brief

Multiple Sclerosis: New Perspectives on the Patient Journey–2019 Update
Summary of an Actuarial Analysis and Report