The votes are in—the final Senate bill to repeal and replace the Affordable Care Act (ACA) was defeated 49-51 in a late night vote on Friday, July 28. The idea of breaking with the norm and fast-tracking legislation is over. The healthcare reform road trip has ended, and what a ride it has been.

The slimmed-down version, just eight pages of the healthcare bill, still wasn’t enough to garner the support needed to pass the bill. Even Paul Ryan’s promise that both House and Senate leadership teams would convene to design a passable version did not provide the leverage needed to pass the bill.

With summer waning and the new school year ahead, I equate this healthcare reform road trip to a family vacation, a break from the norm.

It all starts with the excitement of embarking on a trip where you visit new  and exciting places, plan for new experiences and activities, venture outside your comfort zone, and are convinced that this vacation is just what you need compared to your old, humdrum day-to-day drudge.

The first few days are great. Everyone’s high on the anticipation and introduction of this utopian place. It’s perfect, it’s beautiful—no one ever wants to leave. Suddenly, a few things begin to upset this “picture-perfect” vacation. You wake up with a backache from sleeping in a bed that doesn’t fit you, the new exotic foods you try don’t like you, and the smiles and happy camaraderie that were present when everyone began are replaced with incessant bickering about not wanting to do what someone else wants to do.

Tempers run high and frowns, pouts, foot stomping and sometimes tears result from not liking the choices someone else made for you. The general fatigue of accommodating others and too much togetherness begins to take its toll.

And now, your humdrum drudge is what you look forward to most. At least at home we know what to expect, we know (for the most part) how to function and move forward through our days, even if it’s not perfect.

A number of Republican legislators thought a “new vacation destination”, an alternative to the ACA, seemed like a good possible solution, creating energy and momentum coming in to the 2017; an opportunity to improve on the status quo. It was an opportunity to improve on the status quo.

It turns out, some did not agree on which activities to participate in while others chose not to go on the trip at all.

As a result, the vote “turned the car around” and we head back home to the “normal” environment we are used to. It’s back home to get ready for the “new school year.”

What can we expect this year?

It depends on many factors, but here are a few procedural and pending items on the calendar will receive consideration.

Legislative Activity

• When the House and Senate come back to session following the August recess, they will work, through regular order, to introduce bills and/or sponsor bills to help improve the ACA and address the troublesome spots. New bills will require a simple majority in the House and a supermajority (60 votes) in the Senate to pass. The focus of discussions will be tax reform, which could have an impact on funding to the ACA. Both Republicans and Democrats will likely discuss reform, but additional priorities may delay these activities. The most imminent item will be the Children’s Health Insurance Program (CHIP):
  • CHIP is a state administered program providing health coverage for eligible children covered through Medicaid and separate CHIP programs
  • It is jointly funded by the states and federal government
  • The ACA extended funding through fiscal year 2015
  • Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended funding for the program through fiscal year 2017(September 30, 2017)
  • Additional funding is included in the 2017-2018 budget proposal and will require approval to continue funding

Regulatory Activity

• Regulatory changes are anticipated, as per the Executive Order given by President Trump earlier this year, to ease the burden on individuals and employers. Modifications are allowable in roughly 1,400 areas of the ACA. The Secretary of Health and Human Services (HHS) has named authority to modify these areas.
  • Possible modifications that would affect employers include:
    • Changes or extensions to grandfathered or grandmothered plans
    • Simplification of employer reporting §6055 and §6056
    • Composite rating
    • Continued enforcement requiring proof of qualification for special enrollment period

Any way you look at it, the "new school year" is starting and hopefully everyone will come back from break with renewed energy to once again tackle the challenges facing the healthcare industry.

We will continue working on behalf of our clients, representing their voices, needs, and concerns to those in a position to improve legislation and regulations. We will also be a resource for legislators and regulators at the federal and local levels, and lawmakers and insurance carriers, to develop ideas and solutions that will improve the current health insurance experience.

Visit our ACA Watch Page to stay up to date on new healthcare developments.