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The Path Forward In Health Care Remains Uncertain For Both Parties


Repeal and replace has failed. The Affordable Care Act, otherwise known as Obamacare, lives. But the health care law is not out of the woods yet. Pressure from the Trump administration and threats from Republicans to overturn the ACA with their own bill led to months of debate that ended in a showdown on the Senate floor with the GOP unable to get the support they needed. But some say the bill is not entirely dead and could be revived at a later date.

And this outcome has led to a flurry of tweets by the president today, expressing his disappointment and warning of what is to come. He says, quote, "if a new health care bill is not approved quickly, Bailouts for insurance companies and Bailouts for members of Congress will end very soon." The word bailout is capitalized in those tweets. The way forward looks uncertain, so we called up Julie Rovner from Kaiser Health News to tell us where things stand now. Julie, welcome back.

JULIE ROVNER: Thank you very much.

KING: So, Julie, this was a dramatic end to a contentious debate over repeal and replace. But problems with the ACA still do exist, and the issues still do need to be addressed. How dead is this debate, really?

ROVNER: Well, I think the debate is really not dead. In fact, the bill is not entirely dead. Senator McConnell could actually bring it back if he wanted to, if he thinks he could get a majority for something. That seems unlikely in the near future. But definitely, the debate will continue, both in Congress and in the administration and maybe, now, between Republicans and Democrats.

KING: So it sounds like we're back at square one. Meanwhile, there are still millions of people who are finding it hard to pay for their premiums. Insurers have been pulling out. What is the fix here?

ROVNER: Well, definitely, the Affordable Care Act has problems. It's had problems almost from the beginning. But remember, Republicans took over the House right after the bill was passed, so there hasn't been any compromise to try to address some of the problems. And we're getting, this year, towards the deadline when insurers have to decide whether or not they're going to offer coverage for next year. And that's not entirely clear because of all the uncertainty surrounding what's going to happen.

KING: There have been these frequent threats from the Trump administration to undermine the positions of insurers who are providing plans in the individual exchange, right? Can the administration, as it has said it would, actually facilitate the failure of the ACA and cause it to implode?

ROVNER: Well, the administration is already facilitating the failure of the ACA. And the insurance industry is saying that pretty much every day, in increasingly loud tones, the biggest thing that they're doing is they're threatening, every single month, not to provide what turns into $7 billion in money that's owed to the insurers for discounts that the insurers are giving to low-income people to help them with their out-of-pocket costs, their deductibles and their co-payments. There's a very technical fight and a lawsuit about this.

But the administration is literally deciding, every month, whether or not it's going to provide those funds. And what insurers have said is that because of the uncertainty of that alone, that they're asking for increases of 20 percent for next year. Right now, there are about 40 counties where there is no insurer, I think over a thousand counties where there's only one insurer. So things are not going well. But if you ask the insurers, they'll say, partly that's because of the uncertainty about what's happening in Congress and, in particular, what's happening - what the administration is doing.

KING: From what you're reading and seeing and in your chats with people, do you think there really is bipartisan support to help improve the ACA if this debate comes back around?

ROVNER: Well, if the law fails or big parts of the individual market fails - which is what we're really talking about, the 17 million people who buy insurance in the individual market - the places that are having the most difficulty tend to be more Republican places, and they tend to be Trump voters. President Trump doesn't seem to have sort of made the connection here that the people who will be most hurt are the people who voted for him.

So I think there is an increasing desire on the part of Republicans to do something to stabilize the market. Whether the now-apparent end of this debate to repeal and replace with just Republican votes will move them to be able to get together to address some of these issues - and, as I said, there are ideas out there to address some of these issues - is sort of yet to be seen. I think they may have to think about it for a little while. But they don't have a lot of time to do that.

KING: That was Julie Rovner from Kaiser Health News. Julie, thanks so much.

ROVNER: My pleasure. Transcript provided by NPR, Copyright NPR.

Noel King is a host of Morning Edition and Up First.
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