The Republican plan to replace the Affordable Care Act died Friday before receiving a vote when House Speaker Paul Ryan pulled the American Health Care Act because it did not have enough support to pass.
Ryan said the GOP would move on with other priorities such as tax reform, but there is still much the White House could do to undermine the Affordable Care Act. It’s a stunning turnabout for Republicans who have campaigned for seven years on repealing and replacing the ACA and a major blow for President Donald Trump, House Speaker Paul Ryan and other top GOP members.
The stability of the individual insurance markets is also still very much in question. Payers could only have until June 21 to decide whether they will participate in ACA open enrollment and what their rates will be.
The Republican Party has effectively dropped its promise to immediately repeal and replace the ACA for now. Despite an ultimatum from President Trump last Thursday evening and an insistence from the White House throughout the day Friday that the vote would go on as planned, Ryan pulled the bill from consideration minutes before voting was scheduled to start.
The bill was opposed by separate factions within the GOP. Members of the far-right House Freedom Caucus thought the bill did not go far enough in doing away with the ACA and wanted fewer regulations. More moderate Republicans, however, were concerned with the findings from the Congressional Budget Office that the American Health Care Act (AHCA) would result in 24 million fewer people with coverage. The GOP plan to replace the ACA was not favored by many. Industry groups such as the American Hospital Association and American Medical Association were against it along with the AARP and several doctors’ groups.
“This is a setback, no two ways about it, but it’s not the end of the story,” Ryan said on Friday, declining to offer details for how the GOP would proceed on healthcare reform.
President Donald Trump said the fight was not over but acknowledged that Republicans would turn to other priorities like tax changes and infrastructure plans. So the ACA and its protections for people with pre-existing conditions and promises of preventive care are still the law of the land. Medicaid expansion can also continue. As even states with devoted GOP governors acknowledge that expansion has improved coverage and health stats, more states may be up for increasing their Medicaid population.
It remains to be seen, however, whether Republicans will make efforts to destabilize the markets. Trump had stated on Friday that "Obamacare will explode" and HHS Secretary Tom Price has certain administrative authority bestowed onto him via the ACA to not do the legislation any favors. While the ACA may currently be the "law of the land" as Ryan stated on Friday, a GOP-led government may make for a hard environment for continued progress for the ACA.