Columbia Law School Associate Professor Kristen Underhill, a public health and policy law expert, offered initial comments on House Republican leaders’ abrupt withdrawal of their health-care proposal—the American Health Care Act—from consideration on the House floor earlier today.
Q: What is your reaction to this defeat?
Underhill: It's a relief. Had the bill passed the House, the Senate would have been a much closer question. But a defeat in the House gives us more certainty that some of the ACA's most meaningful contributions will last. The default for 20 million people is now coverage, and affirmative steps to reverse that coverage have become highly visible and, we see now, politically unacceptable.
What are the implications for the exchanges?
There may still be some instability ahead for the exchanges. A central component of financing insurance on the individual markets was protection for insurers on the exchanges, such as the risk corridor payments and cost-sharing reduction payments. The law was designed to work with these supports, and uncertainty about whether the new administration will make these payments will still be a large concern. And although the individual mandate remains, we have yet to see how the new administration will enforce it; there are signs that enforcement will be more lenient. The individual mandate is a key design feature for keeping healthy people in plans, and thus to keep the markets stable.
Any other thoughts?
The defeat is important not just for health insurance, but also for funding essential public health services through the Prevention and Public Health Fund, which funds programming by the Centers for Disease Control and the Substance Abuse and Mental Health Services Administration. This preserves some essential state and local programs, like vaccination, heart disease prevention, and the prevention of lead paint poisoning.
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Posted on March 25, 2017