In the weeks leading up to the collapse of the American Health Care Act, health policy expert Joseph Antos warned Republicans to take their time and improve of some of the provisions in the bill.
And Antos, an economist with the conservative American Enterprise Institute (AEI), earlier warned that the initial plan to "repeal and delay" was unworkable because it would have led to turmoil in the insurance industry.
Now he predicts any move to repeal and replace will not happen soon. But there are some elements of health care that can and must be tackled, particularly Medicaid, he said.
"It's unlikely (Republicans) will take up repeal and replace," Antos told Patient Daily. "It is not as if the issue is going to go way but that does not necessarily mean immediately going back to it. I cannot see any more activity for the next few months."
A standalone health bill will not make it through, he said.
"But we will have to do something about Medicaid," Antos said.
Governors and legislatures in a number of the 19 Republican-controlled states that did not expand Medicaid have signaled they want to get additional federal dollars. The expansion was covered 100 percent by the federal government until the end of 2016 but will drop to 90 percent by 2020.
Most recently, Kansas Gov. Sam Brownback vetoed a Medicaid expansion bill that passed the legislature.
"I am vetoing this expansion of Obamacare because it fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty and burdens the state budget with unrestrainable entitlement costs,” Brownback said in his veto message.
But Antos thinks some compromise can be reached that would allow states to expand Medicaid to cover the most vulnerable and not saddle the country with huge entitlement costs. He frames it as "splitting the difference" between the provisions of the Affordable Care Act and the concerns of the states.
In a recent article, Antos and fellow AEI author James Capretta outlined their plan for Medicaid. The article, written prior to the Republican House of Representatives leadership abandoning the vote on the American Health Care Act, contained the warning to Republicans not to rush a replacement.
Antos and Capretta envisage transitioning to a new national income standard under which there would be "strong federal support for coverage of all state citizens under Medicaid." It would allow more funding for states that did not expand, and the expansion states would phase down to the new standard over time.
The states would be given more control over the way they deliver Medicaid. More support through tax credits would be given to those above Medicaid eligibility but still on living on a low income.
Antos predicted to Patient Daily that exchanges will not collapse because the subsidies increase "dollar for dollar" when the premiums go up. The deductible will be too high, but their premium will not rise so it will be seen as good value, Antos said.
