After GOP Health Bill Failure, What's Next For The Affordable Care Act?

The Affordable Care Act is here to stay — for a while at least. NPR looks at tweaks that could help stabilize the health law's marketplaces.

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It's been just three days since the Republican health care plan failed because it didn't have enough support within its own party. The failure was a huge blow to President Trump and House Speaker Paul Ryan. The question now is, what's next? NPR's Alison Kodjak reports the answer depends on whether Republicans want to fix the health care law or watch it fail.

ALISON KODJAK, BYLINE: Shortly after Republican leaders decided not to bring their health care bill to a vote last week, the president said something he's said many times.

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PRESIDENT DONALD TRUMP: I've been saying for the last year and a half that the best thing we can do politically speaking is let Obamacare explode. It is exploding right now.

KODJAK: What the president didn't say stands out. In the past, he's always added that Republicans could allow the Affordable Care Act to fail but then assured the public they wouldn't. That's left health care industry leaders and policy experts wondering what to expect.

MARIO MOLINA: People need to know. The insurers need to know. What are we going to do next year?

KODJAK: That's Mario Molina. He's the CEO of Molina Healthcare, which sells insurance through the Affordable Care Act exchanges.

MOLINA: I don't think the Affordable Care Act or the marketplace is collapsing, but I do think there are things that need to be done now to stabilize the marketplace for 2018.

KODJAK: Things like allowing states to relax the ACA's requirements for a minimum benefits package, which could lower the cost of insurance in some states. Trump could also ensure that subsidies to help people cover their co-payments are still available, something Republicans in Congress have been fighting in court for years. And Trump could tell the IRS to enforce the so-called individual mandate which requires everybody to buy insurance or pay a tax penalty.

Molina says those actions would go a long way to reassuring companies that have to decide in the next few weeks whether to keep selling health plans through the Obamacare exchanges next year and what to charge for them. Finalizing some new rules that the Trump administration has already proposed to stabilize the insurance market could also help, says Rodney Whitlock, a health policy consultant at ML Strategies.

RODNEY WHITLOCK: The market stabilization regulation that they put out was intended to try to stabilize the market. It was trying to make the Affordable Care Act work better now on their way to transition to what they wanted to do differently.

KODJAK: But if the president is determined to see that market collapse rather than stabilize, he's going to have to take some other action, Whitlock says.

WHITLOCK: The president said on Friday that he would wait - sit back and wait for Obamacare to explode. The problem is, it's not clearly on its way to exploding.

KODJAK: Millions of people still have insurance through the exchanges, and as long as enough insurance companies continue to participate, it won't fall into what many call a death spiral where prices go up and people drop coverage. So nudging it over the edge by reducing subsidies, say, would carry a political risk.

WHITLOCK: The challenge is, if you really want it to explode, how do you do it without being caught with your hands on the plunger?

KODJAK: Whitlock says Republicans are in a bind because whatever happens happens on their watch. Even if they do nothing and insurers drop out of more states...

WHITLOCK: It's hard to blame Barack Obama at this point.

KODJAK: So if they want to really fix the health insurance system and take ownership of the results, they're going to have to make big changes, and those require changes in law. But the collapse of the Republican bill last Friday proved that even if the Trump administration can tweak the system through regulations, they can't take major action without the help of Democrats in Congress.

WHITLOCK: You now know if you want to do health care, you're going to be talking to democrats, or you're not getting it done.

KODJAK: Alison Kodjak, NPR News, Washington.

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