House Speaker Paul Ryan and his allies had what looked like the big gorilla of efforts to change the Affordable Care Act.
Now that the American Health Care Act bill appears to be dead, or, at least is doing a convincing job of playing dead, other ACA-change proposals are getting more attention.
Any would-be ACA changers who want to make some kind of health coverage available to consumers in the individual market in 2018 need to act quickly, because health insurers are supposed to be developing filings for 2018 products now.
Even carriers willing to overlook the reality that making a profit in the individual market has been difficult since January 2014 are having a hard time knowing how they can sell sustainable coverage in 2018 without knowing what the support programs, or basic market rules, might look like.
Here's a look at four possible solutions that are now getting more attention.
Seema Verma, the new head of CMS, owned a company that trained Indiana's HealthCare.gov navigators. (Photo: Senate Finance)
1. Ask Seema Verma.
Tom Bulleit, a Washington-based partner at Ropes & Gray LLP, says in a written commentary about the cancellation of the AHCA bill vote that one obvious outcome could big a bigger role for the U.S. Department of Health and Human Services, and the new HHS secretary, Tom Price.
Price "may undertake larger administrative efforts to roll back Affordable Care Act rules," Bulleit says.
One example, he says, is the ACA essential health benefits package, or requirement that an individual or small-group major medical plan cover at least about 60 percent of the actuarial value of a standardized benefits package that includes 10 types of benefits.
Many Republicans would like to eliminate the EHB package mandate.
"Instead of repealing the 10 essential health benefits, HHS could issue new rules narrowing their definition, which might do a better job of threading the needle between moderates and conservatives than the blunt instrument of outright repeal," Bulleit says.
But Price is an orthopedic surgeon and a former member of the House, not someone who's had much experience with public or private health insurance.
Seema Verma, the new administrator of the Centers for Medicare & Medicaid Services, the HHS arm directly in charge of ACA commercial health insurance programs, such as HealthCare.gov, is famous for being the woman who figured out how to build health reimbursement arrangements into Medicaid coverage for moderately low income adults.
She also owned a consulting firm that has worked closely with private insurers and actuarial firms for years, and her firm had the contract to train Indiana's navigators how to enroll people in coverage through HealthCare.gov.
She's also open to learning more about how the individual health insurance market is really working by, for example, talking to insurance agents and brokers: The Baton Rouge, Louisiana-based Health Agents for America reports that Verma's office is trying to bring HAFA agents in for a meeting.
2. Repealing the Affordable Care Act
Crafters of the AHCA bill called it an ACA repeal effort, but it was really a piece of legislation designed mainly to change ACA budget provisions. The drafters wrote it that way because Republicans hold just 52 seats in the Senate, and a budget measure can get through the Senate with just 51 votes, rather than the 60 normally needed to push a bill onto the Senate floor.
But some members of Congress have already introduced true ACA repeal bills.
Rep. Steve King, R-Iowa, has introduced H.R. 175, the ObamaCare Repeal Act bill, which would simply repeal the Patient Protection and Affordable Care of 2010 and the health care provisions in the Health Care and Education Reconciliation Act of 2010.
Rep. Bill Flores, R-Texas, has introduced a slightly longer bill, H.R. 370. That bill would repeal PPACA and the health care portions of the HCERA, and it would exempt ACA repeal from the usual federal budget impact reduction requirements.
On the one hand: Those bills might do more to increase the number of uninsured people and drive up the federal budget deficit than the AHCA bill.
