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What Is Next for ACA?

Compiled by Laurie Pumper, MPhA Communication Director, from news sources

After multiple efforts to repeal and/or replace the Affordable Care Act (ACA) in the U.S. Senate failed, there are indications that bipartisan proposals will emerge in Congress to help fix portions of the law.


The major options that were rejected in the Senate include:

  • Repeal and Replace: A revised version of the Better Care Reconciliation Act (BCRA) included an amendment that would have allowed insurers to sell plans that don’t comply with some current insurance regulations, as long as insurers also offer a set of plans that do. Insurers would have been able to deny coverage for pre-existing conditions. This bill would have kept two taxes on high-income earners and added state stability funding.

  • Partial Repeal (the Obamacare Repeal and Reconciliation Act): This bill would have repealed coverage provisions in the ACA, including the individual mandate, Medicaid expansion and premium subsidies, but would have let stand insurance market reforms like ensuring a base level of coverage.

  • “Skinny” Repeal: This version would have eliminated the least popular parts of the ACA, but made no changes to Medicaid. It would not eliminate the ACA’s insurance regulations, and was not likely to lower premiums.

Bipartisan Overtures

Sen. Ron Wyden (D-Ore.) made a floor speech in late July that covered the need to pursue a bipartisan approach to fixing the ACA, specifically addressing PBMs and his C-THRU legislation to help control drug costs. Watch his speech (comments on prescription drugs start at about the 20:10 mark).

In early August, Representatives Tom Reed (R-N.Y.) and Josh Gottheimer (D-N.J.) outlined the “Problem Solvers Caucus” proposal in an opinion column in the New York Times. The legislation’s first provision is to make Obamacare’s cost-sharing reductions — payments to insurance companies that defray losses incurred by covering the nonaffluent sick — mandatory.

Another provision calls for a dedicated stability fund — essentially, money for reinsurance — that states could tap when their sickest residents amass medical bills that threaten to drive up premiums for everyone else. The bill would also repeal a medical device tax, loosen the ACA’s employer mandate, and give insurers the freedom to sell plans across state lines.

As of Aug. 4, the Reed-Gottheimer bill had 40 co-sponsors.

Other bills that are more narrowly focused on various aspects of health care are also moving forward.

GOP proposals include refundable tax credits for individuals who do not have access to employer coverage. Those tax credits are similar to the premium credits provided under the ACA. Republican replacement bills repeal the ACA’s individual mandate penalties but impose a premium surcharge or a waiting period to encourage healthy individuals to remain insured. There is general agreement that some such measure — whether mandate, surcharge, or waiting period — is needed to retain regulatory protections allowing people with preexisting conditions to purchase insurance in the individual market.

The National Community Pharmacists Association (NCPA) has and will continue to engage lawmakers on the importance of preserving access to prescription medication and pharmacy services. Senate Republicans’ years-long push to repeal the ACA is stalled for now and could possibly put the short-term focus back on HHS and the Trump administration, which again face looming decisions about the fate of the ACA markets.

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