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What's next for healthcare reform?

By Cal Kellogg, executive vice president of external operations and chief strategy officer, Arkansas Blue Cross

In late March the effort to “repeal and replace” the Affordable Care Act (ACA) supported by President Donald Trump and many in the Republican Party fell short in the U.S House of Representatives. While those of us watching from the insurance industry all understood there were significant disagreements within the Republican Party, no one thought they might be insurmountable.

The end of the effort happened suddenly. House leadership did not have enough votes, so the package was pulled without ever coming to a vote. Ironically, the House that had voted to repeal the ACA several times during the last few years was not able to do so this time. So what is next? As House Speaker Paul Ryan said, this ultimately means the ACA is the law of the land until something changes. While the text of the ACA has not changed and still applies, there is the possibility other changes could still occur during the next few months and years.

If you read the ACA, there are many references that start with the phrase “Secretary shall…” which means the Secretary of Health and Human Services (HHS) can develop rules related to the sales and service of health insurance plans (for example: essential health benefits, special enrollment periods, open enrollment periods, grace periods, etc.). While all of those rules are still in place, remember they were developed by an HHS secretary appointed by a Democratic president. We would expect many of those rules might be revised under Dr. Tom Price, the new administration’s HHS secretary.

Within days of Secretary Price’s Senate confirmation, new proposed market stabilization rules were issued that would change enrollment periods, special enrollment rules, grace periods and more. Now that it will take longer to repeal and replace the ACA through legislative means, we can expect administrative actions to occur that will redefine the market rules within the existing wording of the law. Secretary Price and Seema Verma, the new administrator for the Centers for Medicare and Medicaid Services, have significant latitude in the rulemaking process within the law, and we expect them to exercise that power under the direction of the Trump advisors. That rulemaking process has to follow a well-defined procedure where rules are proposed, public comments are accepted and new rules are finalized. Nothing changes until the rules are finalized. So expect change, but expect it to take a while.

As for legislative changes, you should expect more attempts to repeal, replace or repair the ACA. Just remember, the ACA was not passed during the first year of President Barack Obama’s first term. It was not until the second year of his presidency that it passed. It would not be surprising to see another round of legislative action later this year or early next year to address repealing and replacing the ACA.