What the experts say about latest ACA turn

Area health-policy experts - all members of the Inquirer's Health Cents Advisory Panel - react to the latest failed effort to replace the Affordable Care Act.

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. Sens. 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.

Repeal architects: Sens. Graham (left) and Cassidy.

- Robert I. Field, professor at Drexel University

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 Congress fail to demonstrate any insight that this is a cost issue first. We already spend enough 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

More rigorous evidence

Sisyphus, in Greek mythology, embodies the metaphor of struggling at a task only to meet repeated defeat after heroic (literally) efforts. With the failure of Graham-Cassidy, 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 important, it is a guarantee that the private insurance firms and the state legislatures central to Obamacare's functioning will remain in turmoil.

My biggest concern is that the 90+ percent of the population that is insured, taxpaying, and premium-paying 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 at the Wharton School

Time for tough questions

In the short term, we should protect the ACA'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 ask the tough questions: Is the ACA doing what it set out to? Is it politically possible to set aside the urgency around repeal and replace, and instead take a hard, responsible, bipartisan look at the degree to which this law has succeeded, and where and how it has failed?

- Andy Carter, president, CEO, Hospital and Healthsystem Association of Pennsylvania

Reality has at last set in

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, Jefferson College of Population Health

Groundhog Day all over

Like Groundhog Day, it seems we are destined to wake up every day to another effort to repeal the ACA. Already, there are reports that big GOP donors are insisting 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 from millions.

- Bob Doherty, senior vice president of governmental affairs and public policy, American College of Physicians

Families need real help

With open enrollment quickly approaching, millions across the country are waiting to hear what health-care coverage they will have access to - and what it costs. 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.

Now is the time for elected officials to come together and find common ground, and to put aside politics and open a real dialogue.

- Daniel J. Hilferty, president, CEO, Independence Health Group