ACA Remains After Republican Bill Fails to Pass Congress

What That Means For Health Coverage Now and How It Could Change
Breast Cancer News
April 17, 2017
Eric Fitzsimmons, Copy Editor and Content Coordinator
Reviewed By: 
Shelley Fuld Nasso, MPP

Republicans were not able to pass their bill replacing the Patient Protection and Affordable Care Act, also known as the ACA and Obamacare. The Republican bill, called the American Health Care Act, was introduced in early March and was pulled from a scheduled vote on Friday, March 24 when it became clear not enough people would vote yes for it to pass.

Since the bill was pulled, there has been a lot of guessing about what next steps the government may or may not take going forward. The president himself has sent mixed signals, saying at first that he will not try to reform healthcare again soon, but later saying that he is working on a compromise with other Republicans in Congress. Even if there is no full reform bill to replace the ACA, Republican opposition to the ACA is still likely to bring more changes to how health care is administered.

What Has Changed?

So far, not much. With the failure of the Republican bill, the ACA remains law. This means insurance plans must cover the 10 essential health benefits and must cost the same for people with pre-existing conditions as they do for healthy people of the same age. If you do not get insurance through an employer or the government, you can buy insurance through the online marketplace in your state and you may be eligible for subsidies, financial assistance to help pay for premiums.

Read more about the details of the ACA and what it covers in LBBC’s Healthcare Newsroom.

But President Donald Trump signed an executive order in January telling government agencies to make the requirements of the ACA easier on people and businesses. How exactly this will be enforced has not been seen yet, but it could mean not fining people who don’t buy insurance or certain employers that do not offer insurance for workers. Under the ACA, anyone who doesn’t have insurance is supposed to pay a fine, as are certain employers if they fail to offer insurance options.

You will still find health coverage the same ways you have under the ACA: through an employer, through a government program like Medicareinfo-icon or Medicaidinfo-icon, or through individual plans on a state or federal marketplace. If you lose your job, move to a new state or have another qualifying event, you will be eligible for a special enrollment period to find individual insurance. Otherwise you can change your coverage during the open enrollment period starting in November.

Will Congress Introduce Another Bill to Repeal the ACA?

When the AHCA did not pass, many Republicans said they were not going to work on another major healthcare reform bill in the near future. But since then, there have been several meetings about healthcare law and members of Congress are saying a compromise among different groups is in the works.

Some of these groups met with the Trump administration on April 3 about a new healthcare plan. While the plan is still just an idea and has not been written as a bill or introduced to Congress, people at the meeting said a major feature would allow states to get a waiver so they can allow insurance plans that do not cover the essential health benefits and are allowed to charge people more for having a pre-existing conditioninfo-icon.

These patient protections have been among the most popular parts of the ACA. People like you with breast cancer or other serious conditions are able to find affordable health coverage because insurance companies cannot discriminate against you. Even if the law protecting people with pre-existing conditions remains but the essential benefits end, insurance companies may choose to not cover expensive needs like chemotherapyinfo-icon medicines. But the argument behind getting rid of these protections is that young and healthy people will be able to get minimal insurance plans with a lower premium.

What if Congress Does Not Repeal the ACA?

Congress can pass laws that affect your health care without repealing all of the ACA. But, because of how the ACA is structured, it is unlikely that any of the main features of the law will be changed without a full reform bill. The ACA requires people to buy health insurance. Because healthy people must also buy insurance, companies can afford to cover care for people who have existing conditions and for needs like medicineinfo-icon and maternity care.

If the government no longer requires everyone to have insurance, it’s likely more healthy people will choose not to buy any.  Fewer people paying for insurance means the insurance companies have less money to pay for coverage when sick people need care. If this happens, the government will have to find a way to help pay for people who are getting health care or individual costs will rise and the markets could collapse. But Congress can make small changes that strengthen the markets, like offering more subsidies, or weaken them by making it harder to get assistance.

Outside of healthcare reform, other bills also can affect your health care. One bill has already passed that changes how states award family planning grants for clinics that offer services like counselinginfo-icon, birth control and cancer screenings. This bill would allow states to deny that funding to clinics that offer abortion in addition to their other services. Congress may also add the ban on using Medicaid at Planned Parenthood clinics to another bill, most likely the budget. Medicaid already can’t be used for abortions, so adding this limitation to the budget would stop people going to Planned Parenthood for cancer screenings, treatment for sexually transmitted infections and family planning services that have been shown to lower the number of abortions.

Are There Changes the President Can Make Without Congress?

The president and the executive branch departments that answer to him are able to make changes to the ACA that can affect how you get insurance and health care. One example is that the Department of Health and Human Services issued a rule aimed at stabilizing the marketplace for 2018. Some say the rule benefits insurance companies more than consumers.

Under the new rule, the open enrollment period will last 6 weeks, from the beginning of November through December 15, instead of until the end of January, as it has in past years. Also, if you are eligible for a special enrollment period for things like marriage or losing your job, you may be asked for documents supporting your claim. This could be especially difficult if you, like many people, leave work or change your hours while you are in breast cancer treatment and lose employer-sponsored insurance coverage. Additionally, anyone who misses premiums will be required to repay past-due premiums before enrolling.

The reason HHS is interested in changing the enrollment periods is that it’s been seen under the ACA that people sometimes do not get insurance until they need medical care. These changes would make it more difficult for you to get or change your insurance. The hope is that people will stay insured rather than risk not being able to enroll. But it may result in sick people being kept from getting coverage.

HHS is also changing how plans are classified in the state and federal marketplaces. This allows insurance companies to cut benefits slightly while still classifying a plan as “bronze,” “silver” or “gold.” Insurers could offer lower-cost plans with these changes, but the plans would have you paying a higher deductible and a higher share of some treatment costs. Some experts say this will result in higher out-of-pocket costs and less financial assistance to help people purchase insurance.

Are Other Changes Likely?

The House of Representatives sued President Barack Obama in 2014 over the authority to give financial assistance to insurers as part of the ACA. These cost-sharing reduction subsidies go to companies that offer health insurance with low deductibles and copays to people living near the poverty line. The case returns to court May 22, but President Trump could stop defending the subsidies, allowing Congress to stop providing that assistance. This could affect insurance options especially for people who make very little money. You could see fewer insurance options and higher premiums.

As discussion continues, LBBC will continue to update the Healthcare Newsroom about new developments and how they can affect you.

More In Affordable Care Act

Additional Related Topics 
Health Insurance
Paying for Treatment