Ok, I got my beer and a slice of orange. Now I can make my prediction for how this is going to go.
For a long time now I haven't bothered to share much in the way of analysis. Partly that is because most people simply aren't listening and I have better things to do with my time. Which is to say I can type up articles and actually get a check in the mail for my time and trouble. It's not a lot. Maybe enough for a shopping excursion to Bed Bath and Beyond. I won't be buying an island in the Caymans anytime soon.
Here's the punchline and I'll explain after I say it: The Republicans have fuxored any hope of repealing or replacing the ACA for the forseable future.
At this point, the only way for the Repubs to make any progress with repeal/replace when it comes to the ACA is via the reconciliation process. To do otherwise, they would need 60 votes in the Senate and they can't do this because they'd have to get 8 Democrats onboard.
Which, incidentally, is why we're seeing this headline "White House Opens Door to Democrats in Wake of Health-Bill Failure"https://www.wsj.com/articles/white-house-opens-door-to-democrats-in-wake-of-health-bill-failure-1490547877
So everyone must understand this: in order to have ANY hope of a new healthcare bill, the Repubs are going to have to get at least some of the Democrats onboard. There are several major obstacles though:
1) Republicans and Democrats are largely self serving. Republicans have had success running on a platform of repealing and replacing Obamacare. If they "fix" the problem, they don't get to run on that issue anymore. And they know it. Same thing for the Dems that are in strong "blue" demographic areas. Each side is looking to use healthcare reform as a way to energize their respective bases. In other words, they are willing to sell the well being of the ordinary citizen down the river if it means they can capitalize on the pain of the average Joe or Jane.
2) There is another fight on the horizon in Congress that may well overshadow healthcare reform. At least in the short term. That's "raising the debt limit". This will hit the headlines again sometime around May or June.
3) Yet another big issue the Repubs are dealing with is the budget. Which is going to be something that a lot of Repubs are going to fight each other over because there's a lot of sweetheart spending programs (call it "pork" if you want to) that is in the mix. You better believe that the Dems aren't the only ones looking for government handouts for their constituents.
4) The battle over Gorsuch also remains. This needs to be done by April 6th because there's then going to be a recess and Congress doesn't reconvene until April 24th. (Only in government can a body do practically nothing and then need a 2 week break to take a rest from doing nothing).
The result is that we're stuck with the ACA for a very long time. That means that employers will need to make sure they have solutions in place for all the compliance. And they'll have to have their checkbooks ready to pay all the applicable fees.
There is one wildcard in all of this and that's the Treasury Department. Trump could influence the Treasury not to enforce the employer mandate. This will undoubtedly help to increase jobs, but it's still a bandaid solution.
Right now, the ACA enrollment is taking pressure off Medicare when it comes to Part A funding. If the ACA marketplaces implode, which is happening in certain geographical areas simply because the carrier can't sustain it, that could be a bad thing.
What they should have done is repeal the ACA and pass legislation that:
1) Required any insurance carrier to cover a person regardless of pre-existing conditions
2) Removed state level DOI restrictions on carriers being able to sell across state lines. One of the things that insurance carriers have been allowed to do is create their own fiefdoms where other carriers couldn't create a network and compete. That, ladies and gentlemen, is not the way a free market is supposed to work. That's cronyism any way you want to slice it. State governance shares the blame with insurance companies for this.
3) Work with insurance carriers (which is a nice way of saying drag them to the table by their ear lobes) to create private marketplaces for individual insurance. End the employer mandate and let employers setup HRA accounts that can be used for medical expenses. Or simply provide a certain amount of funding to each employee based on desired coverage level that the employee can use in the private marketplace. These plans will be quite different than the plans currently offered via the ACA marketplaces. The plans would be largely considered to be "catastrophic plans" in nature, and will all have high deductibles. They will not provide things like dental care or prenatal care because they would be individually underwritten.
Lefties, righties, and libertarians who read what I just wrote will all take issue with it for various reasons. That's because it involves actual compromise, which everyone says they want but aren't actually willing to do.