What’s next in health reform?
Predicting the future of federal health care reform through the repeal-and-replace debate
by Kate Alfano, CMS Communications Coordinator
The Affordable Care Act (ACA) is changing, or is it? It is difficult to discern whether it will be repealed, replaced or repaired, particularly as information changes from week to week. The Colorado Health Institute (CHI), a nonpartisan health policy research institute, has deployed a team of analysts to look at this evolving issue and will produce a series of reports through an effort they’re calling “Re:ACA.” The team’s first analysis – “What now? Five next steps for the Affordable Care Act in Colorado and five lessons learned from the repeal and replace debate” – published March 29, comes from Joe Hanel, CHI manager of public policy outreach.
“The 18-day lifespan of the American Health Care Act (AHCA) left many open questions about the future direction of national health policy, but it also clarified the boundaries of the debate,” Hanel wrote. “Affordability of health care and insurance and the sustainability of private and government spending remain the primary challenges.”
Federal lawmakers quickly learned that insurance coverage matters. After the Congressional Budget Office estimated that 24 million Americans would lose health coverage under the AHCA, news reports were flooded with footage of angry constituents at town hall meetings. “Future bills are likely to be judged against the coverage expansion brought by the ACA,” Hanel wrote.
In Colorado, the uninsured rate under the ACA dropped by more than half, from 14.3 percent in 2013 to 6.7 percent in 2015. Colorado achieved near-universal insurance for children, with just 2.5 percent uninsured. An estimated 465,000 people joined Medicaid through the expansion and another 100,000 receive subsidies through Connect for Health Colorado, the state’s insurance exchange. CHI projects that the quick growth of Colorado Medicaid has stabilized to cover roughly one-quarter of the state’s population. “Any proposal, either in Colorado or nationally, that would raise the number of uninsured would have a hard time passing.”
Colorado employs a program called the Accountable Care Collaborative (ACC) that has produced impressive cost savings in Colorado Medicaid since its inception six years ago, but without the federal government’s matching funds under the ACA – which covers 94 percent of the cost of the expansion – the expansion would certainly be unaffordable as state lawmakers already divvy out limited funds among competing priorities.
“With Congress seemingly stalled on health policy, states have a tool to start designing their own systems,” Hanel wrote. “The ACA offers states wide latitude to alter major parts of the law through what’s known as a 1332 waiver, as long as coverage and federal costs are not negatively affected. Congressional approval is not needed for these waivers, although they do need to be approved by the U.S. Department of Health and Human Services. With Congress at a stalemate, it’s possible the next big idea in health policy will be generated at the state level.”
“Republican members of Congress pitched repeal of the ACA and its replacement by the AHCA as a simple fix for the country’s costly health system,” Hanel wrote. “The AHCA’s fate demonstrates that no easy solutions exist. Similarly, for proponents of the ACA, their victory in Congress does not mean that health care problems have been solved. Instead, future reforms will have to diagnose specifically what is wrong with the system and make targeted repairs. The work will be slow and painstaking.”
Follow CHI’s continuing coverage of federal health care reform on their website, www.coloradohealthinstitute.org.
Posted in: Colorado Medicine | Health System Reform