The implosion of the GOP’s effort to gut Obamacare drew a mix of cheers and expressions of dismay across Georgia as health care providers, insurers, consumer advocates, lawmakers and voters struggled to grasp what it means for the future of health care in the Peach State.
One thing is certain: the collapse of the GOP plan means Barack Obama's Affordable Care Act will remain the law of the land for the foreseeable future as Republicans set their sights on tax reform and other key issues.
But will the Trump administration work to shore up the health law they campaigned against in order to help stabilize access to insurance for millions of Americans? Or could they instead undermine Obamacare to score political points and set the stage for a second chance at tackling the politically thorny issue?
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The sudden turn of events in Washington comes at a critical juncture for the health law as insurers prepare to announce next month whether they will continue to offer coverage in the health law’s insurance exchanges. Their decisions will be a key indication of their confidence in the system and will help determine what many Americans must pay for premiums.
Meanwhile, many eyes in Washington and the state will now shift to former Georgia congressman Tom Price.
As President Donald Trump's top health official, Price has unparalleled authority to shape the future of the Democratic health law he long demonized by making tweaks to regulations, some of it without the input of the public or Congress.
He could look to undermine Obamacare by loosening its requirements and creating chaos in the marketplace, or he could try to make improvements to cut down on confusion but risk making the law look too functional.
Trump, for his part, remains steadfast in his belief that Obamacare is an unmitigated disaster, citing double-digit premium increases across the country and insurers fleeing the exchanges.
“ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!” Trump tweeted Saturday morning.
Trump failed to mention that the Republican plan was yanked after the GOP lost support among the conservative and moderate flanks of its own party.
Instead, he predicted that staggering premium increases of between 70 percent and 200 percent would force Democrats — who unanimously opposed the GOP plan — to the negotiating table on health care.
“They’re going to reach out when they’re ready,” Trump said. “And whenever they’re ready, we’re ready.”
But consumer advocates and experts say the exchanges are not in a death spiral as many Republicans have claimed and that premiums will stabilize next year, though the health law could indeed use some fixes.
Graham Thompson, a lobbyist for the insurance industry in Georgia, thinks friendly regulations from Price encourage more competition.
“Of course we’re all watching – I don’t live in DC – but now we kind of refocus on the law as it is and wait to see what direction we do get from Secretary Price and his staff,” Thompson said. “Obviously, that guidance would need to happen pretty fast.”
Fix the Affordable Care Act?
Next month marks a decisive moment for Obamacare.
That’s when insurance companies will tell states whether they plan to offer coverage in the exchanges in 2018 and, if so, how much they plan to charge consumers. The exchanges offer insurance plans for people who don’t get coverage through their employers.
Several big players, including UnitedHealthcare, have already pulled out of exchanges across the country, including in Georgia, citing large losses because the populations they covered were older, sicker and more expensive than anticipated.
Large swaths of rural Georgia have only one insurer available on the exchange, Blue Cross and Blue Shield. That lack of competition has contributed to far higher premiums in rural areas compared to metro areas like Atlanta.
Georgia’s exchange is relatively stable at least in large metros, said Bill Custer, a health care expert at Georgia State University. Those areas saw relatively small premium increases in line with health care cost growth, but some rural areas saw premium spikes of up to 60 percent.
“The Atlanta market is working in every way you would want this to work,” Custer said. “It’s really the rest of the state that needs stabilization.”
There does need to be more focus on encouraging younger, healthier people to buy coverage to help balance out those who are sicker and have higher health costs, said Laura Harker, a health policy analyst with the left-leaning Georgia Budget & Policy Institute.
With the GOP plan now off the table, “we’ll have to think more about how to fix the problems with the Affordable Care Act,” Harker said.
Future of exchanges uncertain
The future of insurance exchanges in Georgia and other states may largely lie in the hands of Secretary Price.
After Trump issued an executive order on his first day in office directing federal agencies to ease Obamacare’s regulatory burden, Price took steps to give states extra flexibility in implementing the Affordable Care Act.
The secretary also signaled in a recent letter to governors that he was opening the door for states to add work requirements to Medicaid, long a priority of conservatives. He could move on similar directives in the future.
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Health care experts recently interviewed by The Atlanta Journal-Constitution said Price could loosen requirements for the types of birth control insurance companies are required to offer their customers free of charge under Obamacare.
Price could also make system-wide changes to Medicaid through a special innovation office that Republicans had long maligned. And while he can't touch the 10 "essential health benefits" that Obamacare requires insurers cover such as emergency room trips, maternity care and mental health services, he can unilaterally water them down.
“The outlines of that in the law were very vague,” Thomas Scully, head of HHS’ Centers for Medicare and Medicaid Services under the George W. Bush administration, previously told the AJC. “So the details about how those are designed and what are in those packages are basically all administrative.”
The Trump administration could also take aim at the ACA’s cost-sharing subsidies after winning a lawsuit in May to stop them. The subsidies are aimed at helping the poor pay their out-of-pocket health costs.
Without those dollars, some people may have to drop coverage — putting a heavy burden on hospitals to care for an influx of newly uninsured patients, said Custer with Georgia State.
“It’s something they could easily pull the trigger on,” Custer said.
Price has yet to indicate how he will act since the GOP health bill crashed Friday.
‘Dropped the ball’
It wasn’t just the healthcare industry that was reeling from Friday’s sudden developments. In political circles, the fallout was fierce. Some Republicans, who thought Trump’s win would finally lead to the repeal of Obamacare, were left exasperated. Meanwhile, critics of the bill breathed a collective sigh of relief.
Some Republicans were frustrated with the Freedom Caucus, the arch-conservative group that banded against the measure because they said it failed to go far enough in rolling back spending under Obamacare.
“Once again, we’ve let perfection get in the way of progress,” said Justin Tomczak, a Cobb conservative activist. “Effective governing is moving the ball forward, and yesterday Congressional Republicans who opposed the reform efforts dropped the ball.”
Ellen Diehl, a DeKalb County insurance broker, knew who she wasn’t blaming: Trump.
The GOP had seven years to come up with a workable plan, she said, laying the fault, in part, at the feet of congressional Republicans.
“It’s time for the Democrats to own their failure,” Diehl said. “Let’s let the system collapse so the whole country can see what a failure piece of garbage Obamacare is. I wish there was something we can do to save it, but it’s a lost cause.”
Other Republicans remained more optimistic.
“I’m a little disappointed. This might have been the best shot we had. But it might end up being a blessing in disguise,” said Jim Jess, a Marietta tea party organizer. “We might wind up with something better out of it. But there’s so many moving parts. It’s too early to tell.”
Meanwhile, critics of the GOP bill were relieved by its collapse.
An estimated 750,000 Georgians could have lost their health insurance under the GOP plan, a Georgia State University analysis showed. That would have meant a flood of newly uninsured patients for hospitals, which already provide $1.75 billion in free care every year.
The GOP plan would have jeopardized access to care for hundreds of thousands of people and hurt hospitals' ability to meet patients' needs, said Earl Rogers, president of the Georgia Hospital Association, which opposed the plan.
“When more Georgians have access to affordable health care insurance, our population is healthier, our state’s economy is stronger, and our hospitals are better equipped to deliver the right care in the right place at the right time,” Rogers said.
The bill would have been a raw deal for Georgians — eliminating the requirement that insurers provide people with essential coverage, such as maternity care and mental health services, said U.S. Rep. Sanford Bishop, a Georgia Democrat.
“It would have made health care less affordable and less accessible across the board,” Bishop said.
Several Democrats who attended a town hall in Gwinnett County Saturday said they were glad the GOP plan failed, but they weren’t giddy. Obamacare needs to stay, but be fixed, they said. Politicians need to put aside partisanship and do it.
“We need to look at the ACA and fix the problems it has,” said Grant Christopher, a 32-year-old IT worker from Lawrenceville. “We need to increase the income levels for subsidies so more people can afford the premiums. A lot of my friends are in that bubble where it just doesn’t make sense to pay for it.”
‘These problems aren’t going away’
As for a health care overhaul on Capitol Hill, the road ahead has narrowed significantly.
The Senate is highly unlikely to take up legislation similar to what sank in the House. For starters, there does not appear to be enough Republican support for a measure similar to the House bill. In order to unlock the special procedure that allows the GOP to avoid a Democratic filibuster on health care reform, the Senate would need the House to act first. That, or find a health care proposal that could notch 60 votes in the Senate, which is all but impossible given that it would require eight Democratic votes.
It’s possible that a group of more moderate Republicans and Democrats could form in the Senate to try and repair Obamacare, but it’s unlikely they would get a commitment from GOP leaders in both chambers to bring up any final product for a vote, particularly ahead of the 2018 mid-term election.
In the meantime, it’s unclear how last week’s news could impact Republicans at the ballot box. Ryan, Trump and GOP members of Congress campaigned for years on the pledge that they would repeal and replace Obamacare if elected, and Friday’s actions undoubtedly represent a major setback.
Some Georgia Republicans were optimistic the party could bounce back.
"I don't believe that anybody's failures today are irremediable between now and 2018," U.S. Rep. Rob Woodall, R-Lawrenceville, said Friday. "I absolutely hope that we're going to have more opportunities. This wasn't some sort of academic exercise — those problems aren't going away, and so you can game that out 100 different ways."
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