Area health policy experts – all members of the Inquirer's Advisory Panel – react to the week's news about the latest failed effort to replace the Affordable Care Act.

We need a “more constructive bipartisan approach.”

One of the most destructive aspects of the failed Graham-Cassidy effort was its preemption of a true bipartisan initiative to find ways to improve, rather than gut, the ACA. Senators Lamar Alexander for the Republicans and Patty Murray for the Democrats were leading negotiations that should have started seven years ago – an effort to seek workable compromises to maintain health coverage for the greatest number of people. Now that Graham-Cassidy is off the agenda, perhaps the Senate can direct its attention back to the more constructive bipartisan approach. — Robert I. Field, professor of law and health management and policy at Drexel University. 

Congress should “refocus efforts on CHIP reauthorization.”

We call on the Administration to end its efforts to sabotage the Affordable Care Act that have included reducing funds available to publicize this year's Open Enrollment period, cutting the number of navigators available to help individuals understand and sign up for insurance coverage through the marketplace, and refusing to approve cost-sharing reductions that would allow insurers to offer more reasonable rates for 2018, among others. Lastly, we call on Congress to focus efforts on CHIP reauthorization and making sure health centers are fully funded. — Antoinette Kraus, director, Pennsylvania Health Access Network

“There is little rigorous evidence that coverage … has an appreciable effect on health.”

Sisyphos, in Greek mythology, embodies the metaphor of struggling at a task only to meet repeated defeat after heroic (literally) efforts.

With the failure of the Graham-Cassidy plan, can we expect a repeat of the story?  One reason to think the answer will be yes is that the alternative — administration of a partisan Democratic plan by a Republican administration and a Republican Congress who oppose it — is a recipe for major deviations from fidelity to the letter and spirit of that bill. More importantly it is a guarantee that the private insurance firms and the state legislatures central to Obamacare's functioning will remain in turmoil.

The promises made by original endorsers of the bill (no change in coverage, lower premiums) have largely failed to be fulfilled.   But there has been a 40% fall in the uninsured proportion.  However, at present only 3% of Americans buy insurance through the exchanges and about the same percentage were insured by the partial expansion of Medicaid, so the fundamental key about what happens next is what the 90+ percent of the American population that is insured, taxpaying, and premium paying prefers.

My biggest concern is that this group is far from agreement on which way to go, much less what to do.  Unfortunately, there is little rigorous evidence that coverage even for the poor has an appreciable effect on health (despite the correlation between poor health and being uninsured).  Absent that evidence, we are going to see that boulder rolling again. — Mark Pauly, Professor of Health Care Management, Business Economics and Public Policy at The Wharton School

Focus on the right issues

The ACA and the repeal and replace attempts are both failures because they focus on the wrong issue. It is remarkable that the press and the Congress fail to demonstrate any insight that this is a cost issue first. We already spend enough money to care for everyone in the country. We don't focus on cost because it would require hospitals, insurance companies, big pharma and physicians to change their business models. Insurers, providers and pharma contribute huge dollars to Congress and Congress works only on how to get enough money each year to keep these organizations going the same way they are. — Howard Peterson, managing partner, TRG Healthcare.

Quality of care should be rewarded

We need to implement a plan that rewards quality of care, allows insurers to negotiate drug prices, continues to increase the patient base so there is not adverse patient selection, limits the profits of major insurance companies, and decreases medical waste. Please include practicing primary care physicians, hospital administrators and patients in the planning group. — Paula Stillman, MD,  director of community engagement at the Institute of Emerging Health Professions, Jefferson University

Honor ACA’s cost-sharing reduction provisions.

In the short term, we should protect the Affordable Care Act's individual mandate and honor its cost-sharing reduction provisions. These are what insurers in Pennsylvania are saying they need to stabilize the individual market and moderate premium increases.

In the long term, we need to start asking the tough questions: Is the Affordable Care Act doing what it set out to? Has it improved health and health care—by giving more people access to comprehensive health coverage—thereby driving toward reductions in per capita health care spending? Is it politically possible to set aside the urgency around repealing and replacing Obamacare, and instead take a hard, responsible, bi-partisan look at the degree to which this law has succeeded, and where and how it has failed? — Andy Carter, President and CEO, The Hospital and Healthsystem Association of Pennsylvania

It’s a battle of rhetoric versus reality.

The effort to repeal and replace Obamacare is really a battle of rhetoric versus reality.

Obamacare contains many things people want: insurance without preexisting condition restrictions, comprehensive coverage, no lifetime caps, prevention coverage, and subsidies for those needing help to pay premiums. Obamacare also expanded Medicaid coverage in many states to include the near poor who can't afford insurance at any price.

Like the proverbial dog catching the bus, the Republicans came out of last year's election with the unexpected power to get a repeal bill passed. Reality set in when Americans learned that millions would lose coverage or see their premiums rise if any of the proposed plans were passed. Many of the affected are Republican voters who might turn on the politicians who took away their health care. The party's challenge is how to fulfill the promise of repeal without impacting its tangible benefit. — Drew Harris, program director for the master of science in health policy program at the Jefferson College of Population Health

We need to write the final script.

My organization, the American College of Physicians, has repeatedly warned Congress that this bill, and other "repeal and replace" proposals, would have brought back the days when insurers in many states could charge more to sick people, put annual and lifetime dollar caps on their coverage, and fail to cover the health care they need.  It also would have decimated Medicaid.

But like Groundhog Day, it seems like we are destined to wake up every day to another effort in Congress to repeal the ACA.  Already, there are reports that big GOP donors are insisting that Congress try again. We need to write the final script to put an end to health care's Groundhog day, through grass roots advocacy against any effort to take coverage away from millions. — Bob Doherty, senior vice president of governmental affairs and public policy, American College of Physicians

Medicaid is the one and only safety net for some people.

Hidden in all of the recent congressional proposals are dramatic cuts to Medicaid, which is the largest insurer for children in this country. Together with the Children's Health Insurance Program (CHIP), for which funding lapses this week unless Congress acts, Medicaid insures nearly half of the children in this country and more than half of all children with special health care needs. For these latter families, Medicaid is their one and only safety net. At the end of the day, no protections for people with pre-existing conditions can ever be considered complete without acknowledging the need to protect funding for children's health coverage through Medicaid and CHIP. — David Rubin, pediatrician and director of PolicyLab at The Children's Hospital of Philadelphia

We need government leaders to commit to stabilizing the individual market.

With Open Enrollment quickly approaching, millions of people across the country are waiting to hear what health care coverage they will have access to – and what it will cost. We need government leaders to commit to stabilizing the individual market and funding cost-sharing reductions that provide financial assistance to working and middle class families.

We also believe in the importance of ensuring that Medicaid is sustainable for generations to come. However, there needs to be additional dialogue about how we best achieve that goal and continue to take care of our most vulnerable citizens.

Now is the time for our elected officials to come together and find common ground, and to put aside politics and open a real dialogue. Americans deserve a strong, stable health care system that delivers affordable coverage and access to quality care. — Daniel J. Hilferty, president and CEO, Independence Health Group