Trumpcare May Have Died But That Doesn’t Mean Obamacare Is Safe

TOPSHOT - US President Donald Trump speaks to Speaker of the House Paul Ryan after signing House Joint Resolution 41, which removes some Dodd-Frank regulations on oil and gas companies, during a bill signing ceremony in the Oval Office of the White House in Washington, DC, February 14, 2017. / AFP / SAUL LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
SAUL LOEB AFP/Getty Images

The American Health Care Act (AHCA) suffered a stunning defeat in the House of Representatives on Friday after GOP leaders pulled the bill from the floor. But that doesn’t mean the health law it was attempting to dismantle and supplant, Obamacare, is quite out of the woods.

While it’s possible the demise of the House GOP health care bill, or Trumpcare, doesn’t preclude the Republican Congress from revisiting health care reform, the early signals don’t suggest it’s something lawmakers are eager to take up anytime soon. “We’re going to be living with Obamacare for the foreseeable future,” said House Speaker Paul Ryan in a dour press conference after the legislation was shelved (which followed a Thursday night ultimatum from President Donald Trump where he warned that he would leave Obamacare in place if the House failed to pass the AHCA on Friday).

House Energy and Commerce Committee chair Greg Walden also confirmed that the current bill is dead, so it seems unlikely that any sort of comprehensive reform is in the cards this Congressional session. But the Trump administration and Congress can still do plenty to undermine Obamacare in the meantime.

Click here to subscribe to Brainstorm Health Daily, our brand new newsletter about health innovations.

Both houses of Congress and the White House are still mostly staffed with severe critics of the health law. And considering that President Trump has previously argued that he’ll simply allow Obamacare, which he says is already “failing,” to collapse under its own weight and then blame Democrats (Trump responded to Friday’s defeat saying the best thing to do is to let Obamacare “explode”), there are a number of moves the GOP can make to weigh down the ACA.

The White House had already emphasized that repealing and replacing Obamacare would come in three steps: 1) the main AHCA legislation that hit a buzzsaw in Congress Friday; 2) regulatory relief from the Department of Health and Human Services; and 3) follow-on legislation to shore up the last bits of reform.

HHS Secretary Tom Price can take a number of unilateral administrative actions to undermine Obamacare—in fact, the Trump administration has already done exactly this. In February, the White House proposed a number of changes weakening the law’s mandate for people to obtain (largely subsidized) insurance coverage, among other measures—a critical policy mechanism for making sure that a broad enough mix of people buy individual insurance plans and keep the marketplaces stable.

Trump also pulled back advertising for the federal website just before the crucial final weeks of 2016 Obamacare open enrollment. This decision, alongside general uncertainty over whether Obamacare would even make it one more year, likely helped lead to far fewer signups than expected, including among the younger, healthier crowd which tends to wait until the last minute to buy coverage.

There’s also the matter of insurer uncertainty, which is a massive albatross round the neck of an industry whose very job is to deal with risk. Some insurance companies continued in the ongoing Obamacare exodus on fears they wouldn’t actually have a business to take part in; firms will soon have to set their premium rates for 2018 coverage, and the overall confusion won’t make that process easy for them.

And there are still far more actions that ACA opponents can take. For instance, they can agree to undermine Obamacare’s subsidies that help certain customers pay their deductibles and high out-of-pocket costs—in fact, a pending House of Representative lawsuit seeking to nix these subsidies is already underway; states which want to expand Medicaid may have to pursue far more conservative plans in order to obtain special waivers from the government.

After passing by the skin of its teeth in 2010, surviving multiple lawsuits and Supreme Court showdowns, and even living through an all-out onslaught from an adversarial president and lawmakers, Obamacare may seem like the health legislation with nine lives. But that doesn’t mean it still can’t be maimed.

Subscribe to Well Adjusted, our newsletter full of simple strategies to work smarter and live better, from the Fortune Well team. Sign up today.

Read More

COVID VaccinesReturn to WorkMental Health