by Shoshana Krilow
Vice President, Public Policy and Government Relations


It’s the end of the world as we know it. Buckle up, this is only the beginning. Who knew health care could be so complicated?

Whoever said it – whatever they said – the road to health care reform, part two, hit a pretty massive speed bump on Friday, March 24, 2017. By all accounts it was dead in the water, until earlier today. To recap: Republicans in the U.S. House of Representatives needed 215 votes to pass their bill – the American Health Care Act (AHCA) – but were unable to reach a deal to get the necessary votes. By some counts, they were set to come up nearly 40 votes short. This only serves to underscore the complexity of finding consensus on health care even within a single party.

At the end of the day (sorry for the additional cliché), both hardline conservatives and some moderate Republicans in the House determined that the AHCA did not contain enough of their priorities to lend their support, dealing a significant blow to Speaker Paul Ryan and President Donald Trump. In response, Speaker Ryan, with the president’s support, chose to pull the bill from the floor, versus take a vote on legislation they knew would not pass the House.

So, now what?

Our crystal ball is still hazy on specifics, and based on the events of the last six months (or six minutes!), we know better than to predict. Our political instincts and experience tell us that the complete overhaul or “repeal and replace” of the ACA is likely off the table for the foreseeable future. The Senate, always considered the more difficult chamber to pass substantial legislation, has so far shown no interest in stepping in to consider comprehensive “reform” legislation that seems to have no future in the House. Previously in similar circumstances, the House would have been likely to take this loss and move on. Using history as a guide, the next step would be for members of both parties to work together to repair, versus replace, the ACA with piecemeal legislation to both strengthen the insurance marketplace and ensure affordability.

However earlier today, our instincts were challenged and historical precedent is no longer necessarily a guide, as the House and the White House signaled that “repeal and replace” is NOT over, and that they are closer than ever to reaching consensus. Will President Trump and Republicans in Congress take another shot at the AHCA? Or will they allow the current ACA, which they argue is already collapsing, to fail?

Here is what hasn’t changed: there is no indication any Democrats in Congress will support anything that falls into the “repeal” bucket and Republicans in Congress still have a lot of work to do to find consensus among Republicans to pass legislation in the House.

At least for now, the concerns raised about the increase in the uninsured and uncompensated care by many provider stakeholder groups – including Vizient, the American Hospital Association, the American Medical Association and others – still remain unanswered. And at the same time, many of the underlying criticisms with the current ACA – such as lack of competition and spiking premiums in some markets – remain with no clear solution in sight.

In the meantime, much needs to be done in the near future to ensure marketplace stability and affordability, and Congress and the administration have yet to show their hand on these issues; although a proposed regulation on the insurance marketplace is pending from the Department of Health and Human Services (HHS). We expect HHS will decide soon what direction the administration plans to take on these open issues and will begin issuing guidance or regulations illuminating a path forward. And, for many in health care, where exactly that path will lead is the key question at this point.

Although uncertainty remains about the ACA, things like the mandate penalties, insurance credits, Medicaid and marketplace coverage, and value-based delivery system reforms will continue, for now. And for the time being, Congress and the White House will leave these to HHS, and will likely direct their focus elsewhere (such as the incredibly complex issue of reforming the tax code).

Though the entirety of the health care sector may be breathing a sigh of relief that uncompensated care isn’t going to skyrocket overnight, don’t count your chickens quite yet (clichés seem appropriate now). We are still in uncertain times, and many questions remain unanswered. As the situation continues to unfold, Vizient’s office of public policy and government relations will continue to monitor developments and advocate on behalf of the members we serve.

About the author. As vice president of public policy and government relations, Krilow leads Vizient’s government relations, monitoring federal legislative and regulatory developments of importance to Vizient and its members. She has worked as a strategic advisor to health sector clients with a particular concentration on Medicare, the pharmaceutical and insurance industries, and the Affordable Care Act. Krilow also brings deep legislative expertise having spent several years on Capitol Hill, where she worked as a health policy advisor for Representative Marion Berry (D-AR) and Senator Joseph Lieberman (I-CT).

Published: March 28, 2017