Obamacare repeal, replace discussions likely to resurface

Aug. 20--TUPELO -- Despite the dramatic defeat of Obamacare repeal efforts last month, it's likely to remain on the agenda when Congress returns to Washington D.C. after Labor Day.

"I, for one, don't think it's done yet," said American Health Lawyers Association president Eric Zimmerman, who was among national and state experts who spoke earlier this week at a nonpartisan health care reform forum in Tupelo.

The stakes are high, and chaos and uncertainty don't serve Mississippians or health care providers, said Mississippi Insurance Commissioner Mike Chaney.

"People who would be really hurt are in the rural areas of the state," Chaney said, where there's already issues around accessing health care.

Zimmerman and Chaney were joined at the forum by Mississippi Hospital Association president Tim Moore, state Sen. Hob Bryan, Bob Moore of the Mississippi Insurance Department and retired health care executive Gerald Wages.

More than 90 people registered for the four-hour event at the Link Centre sponsored by law firm Bradley Arant Boult Cummings, Mississippi Healthcare Financial Management Association, Mississippi Health Advocacy Program and CATCH Kids.

Zimmerman, who is based in Washington D.C. and is a recognized expert on Medicare law, said it's been very frustrating for Republicans in Washington that health care reform has consumed so much oxygen without producing concrete legislative victories.

"In November, it looked like the world was their oyster," Zimmerman said.

The repeal and replace efforts focused on three titles of the Affordable Care Act. Those efforts were hampered by lack of consensus on a replacement, public support for certain provisions of the law and the mechanisms of the reconciliation process. Medicaid funding reform, which has long been a Republican objective, generated opposition from state leaders.

"Maybe that was a bridge too far," Zimmerman said of bundling Medicaid funding reforms with repeal and replace. "States grew very concerned about what it would mean for their budgets."

Currently there are bipartisan efforts led by Sen. Lamar Alexander, R-Tennessee, who chairs the Health, Education, Labor and Pensions Committee, and Sen. Patty Murray, D-Washington, who serves as the ranking member on that committee. It's not clear those efforts will gain enough momentum to break through the hardened positions on both sides of the political aisle, Zimmerman said.

It's likely Republicans will mount another repeal effort.

"If they're going to move forward, they're probably going to have to come up with a more narrow approach," Zimmerman said.

The executive branch will also have a great influence in what happens next for the Affordable Care Act.

"If Congress does nothing further, the ACA continues to be a very fragile system," Zimmerman said.

The Trump administration has great latitude in enforcing the insurance mandate, noting that the Obama administration took great liberties to patch problems, Zimmerman said.

"One of the biggest wild cards is how much effort will the administration put behind sustaining the ACA markets," Zimmerman said. "We are coming up against some critical, critical deadlines."

Stabilizing

insurance

The Mississippi Insurance Department has seen success in working to stabilize the health insurance market and keep insurance available to more people, Chaney said during the forum. Both the Obama and Trump administrations have been open to working with the department on transitional insurance policies.

These grandfathered health insurance plans don't meet the Affordable Care Act requirements for essential health benefits. In Mississippi, about 250,000 people rely on these transitional policies either purchased individually or accessed through small group insurance markets, which includes businesses with fewer than 50 employees.

"They were supposed to end in 2017," Chaney said.

Because these policies are less robust than ACA plans and aren't subject to ACA taxes, they are much less expensive. These people using these plans would face 65 percent rate increases if they had to move into ACA compliant plans, Chaney said.

The Obama administration extended the waiver period twice. Health and Human Services Secretary Dr. Tom Price has extended the waiver period for 2018 and indicated he will extend it for 2019, too.

Cost-sharing reductions, which help cover out-of-pocket costs for those who qualify on the exchanges, have been extended for August, but Chaney said he does not anticipate they will be extended long term. If the cost-sharing reductions are discontinued, insurers will likely pass on increases to consumers or pull out of the market.

"There's not a lot of positive options out of this," Chaney said.

They are closely watching the lawsuit initiated by Republican leaders in the U.S. House of Representatives that seeks to have the cost-sharing reductions discontinued.

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