WASHINGTON _ Friday's death of the Republican health care legislation surprised lawmakers, stakeholders and voters alike.
Since many Americans don't realize Obamacare and the Affordable Care Act are the same thing, McClatchy offers a quick Q&A on what the failed repeal effort means for consumers.
Q: I don't get it. How could the Republican-led House _ which voted more than 50 times to repeal the Affordable Care Act _ fail to pass it when they had the chance?
A: The quick answer is it's easy to vote against something when it stands no chance of becoming law. It's much harder to gain consensus on new legislation _ particularly when it would rescind benefits that millions of Americans have enjoyed for several years. By demonizing the Affordable Care Act for seven years, Republicans built what turned out to be unrealistically high expectations among their conservative base that the law would be scrapped as soon as possible. GOP leaders quickly realized it would be politically more difficult than they expected. They tried to make compromises and retain certain aspects of the law, while terminating others. Conservative hardliners affiliated with the tea party wanted no parts of what they felt was a watered-down repeal bill. Rather than compromise, they stood firm and forced House Speaker Paul Ryan and President Donald Trump to cancel the scheduled House vote on the measure.
Q: So what happens to my marketplace coverage now?
A- If you've got individual coverage for 2017, sit tight. You're OK. Your plan benefits are signed, sealed and must be delivered.
Q: Does that mean Obamacare is safe for now?
A: Ryan said the Affordable Care Act is the law of the land "for the foreseeable future," and Trump said he expects congressional Democrats will end up working with Republicans to fix any problems or weaknesses in the law. But don't expect the Trump administration to do much administratively to help support the Affordable Care Act.
Q: What about next year? Will individual coverage cost more?
A: Hard to say. The Obamacare tax credits and subsidies will help most marketplace plan members pay for coverage. The lower a person's income, the larger tax credit they receive. And because the tax credits pay a certain percentage of the actual cost of coverage, most recipients are fairly well-insulated from any major rate hikes next year. That said, the Trump administration is proposing policy changes for the individual insurance market that don't require congressional approval _ and could greatly affect the cost and scope of coverage.
Q: What kind of changes?
A: The proposals allow insurers to cover a lower percentage of medical costs and to redirect current premium payments to a plan member's previously unpaid premiums. Those provisions could potentially increase out-of-pocket costs for consumers. In addition, Trump has directed the Internal Revenue Service not to enforce the Affordable Care Act's individual mandate that requires most people to have health insurance or pay a fine. That's expected to cause millions of healthy, younger people to drop their coverage. That would leave plans with a larger share of sicker, higher-cost enrollees which could cause insurers to raise premiums to make up for the extra costs.
Q: But didn't marketplace premiums skyrocket this year anyway?
A: Premiums in states that use the federal HealthCare.gov marketplace did increase an average of 25 percent in 2017, after rising just 2 percent in 2015 and 7.5 percent in 2016. But that was mainly because insurers had under-priced their coverage in 2015 and 2016 because they didn't know what the mix of young, old, healthy and unhealthy plan members would look like _ or how much they would cost. After making the cost corrections in 2017, most analysts felt the individual market was on its way to stabilizing in 2018.
Q: What about the Medicaid expansion? Are congressional Republicans going to go after that?
A: The Medicaid expansion is part of the Affordable Care Act and will remain in effect. But Republicans have their sights on cutting Medicaid and could pursue separate legislation that changes the program from an open-ended entitlement to one with capped funding _ as the GOP health bill would have done.
Q: So what will Republicans do about health care now?
A: In the short term, probably not much. Burned by the debacle that occurred in the House on Friday, Republican leaders will be loath to plunge back into a contentious debate. But many are still quite eager to repeal the law, so look for some to float solutions. "Congress has a responsibility to continue its work to solve this problem," said Sen. Lamar Alexander, R-Tenn., chairman of the Senate health committee. Of course, if their constituents don't make a fuss, lawmakers will turn their sights elsewhere.
