As ACA Replacement Efforts Continue, Uncertainty Remains

President Trump addressed a joint session of Congress and the nation earlier this week outlining a handful of principles meant to guide Congress as efforts to repeal and replace the Affordable Care Act (ACA) move forward. But the specifics as to what would replace the law still leave many unanswered questions. Last week’s leak of the Republican party’s draft plan similarly did little to soften the uncertainty that has been surrounding nearly all sectors of the healthcare industry since President Trump announced his plans to rework Obama’s signature plan.

The recent swath of constituents voicing concerns at town halls throughout the country, concerned about the uncertain status of a replacement plan and its impact on individual coverage, has further set the tone surrounding the topic of healthcare.

This week we take a closer look at these recent developments as efforts to overhaul the ACA continue.

Trump outlines preliminary healthcare vision to Congress

In Tuesday night’s address, President Trump outlined a loose healthcare plan to help revamp the ACA, where he called on Congress to repeal and replace Obamacare with reforms that expand choice, increase access, lower cost and at the same time, provide better healthcare.”

The five principles that Trump laid out for Congress aim to:

  • “Ensure that Americans with pre-existing conditions have access to coverage”
  • “Help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts”
  • “Give our great State Governors the resources and flexibility they need with Medicaid”
  • “Implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance”
  • “Give Americans the freedom to purchase health insurance across State lines”

Trump also alluded to drug reform when he referred to the Food and Drug Administration’s (FDA) approval process as “slow and burdensome” implying that current protocols may inhibit much-needed medical advancements.

Trump’s remarks essentially backed the major components of a Republican bill to replace the ACA yet the ideas were broad and lacking clarity, not only for GOP lawmakers as to how they are meant to deliver on Trump’s promises but also for the American people who are still worried about the status of their healthcare.

Insight into new plan emerges with draft bill

Although likely to change as the bill goes through an evaluation process and ultimately the Congressional Budget Office (CBO), the Republican draft plan offered some new insight into what Americans and the healthcare industry can potentially expect from the Trump administration’s new healthcare offering.

As Politico reported, the new plan would dismantle much of the ACA’s foundation, including subsidies based on people’s income—instead basing it on a person’s age, and all of the law’s taxes. It would also eliminate the ACA’s Medicaid expansion in 2020 and give states money to create high risk pools for some people with pre-existing conditions.

The future of Medicaid has been uncertain since Trump announced his plans to dismantle the ACA. According to STAT, under the draft plan, if spending is capped and states have more wiggle room in what ailments they decide to cover, individuals with significant medical issues could be vulnerable. Also at risknew breakthrough treatments, which could be unaffordable under new program changes. SF Gate reported that according to a recent report by Avalere Health and McKinsey & Company, “the changes under consideration by the GOP-led House would reduce significantly federal funding for Medicaid and subsidize private insurance, creating funding gaps for states and threatening a loss of coverage for many participants.”

The new plan would also repeal the essential health benefits requirements leaving decisions about what coverage to requirewhich under the ACA included mental health services and substance abuse treatmentsin the hands of individual states. For a country in the midst of a severe opioid epidemic, the elimination of this provision could be devastating. “The fear is plans might look to limit that coverage because people with addiction issues are expensive to treat and therefore cover,” reported STAT.

Party divisions over replacement plan

Although the leaked draft, as well as Trump’s comments during his address to Congress, have provided a loose outline as to what the new plan could entail, the status of critical policy remains up in the air and reports of a divide within the Republican party surrounding the bill under development is leaving many feeling a replacement is a ways off.

Several House conservatives and key senators have voiced that they will not support the plan currently being developed. SF Gate reportedthe opposition from conservatives greatly complicates leadership plans to pass legislation in the House before the Easter holiday that would repeal former President Barack Obama’s health law and replace it with a different system built around tax credits, expanded health savings accounts, and high-risk pools.”

Despite assurances from Speaker of the House, Paul Ryan, that everything is on track, conversations within the Republican party about what to replace the ACA with (and what to keep) seem strained at best. However, perhaps most telling is the outcry from party constituents over the past few weeks demanding answers to the status of their healthcare and looking for their voices to be heard.

Next week we will take a look at the public response surrounding the status of a replacement plan and the ideas proposed from the Trump administration so far.