The American Health Care Act: What’s Next? In a time of uncertainty about health care’s future, ASHA’s seven policy statements guide advocacy. Policy Analysis
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Policy Analysis  |   June 01, 2017
The American Health Care Act: What’s Next?
Author Notes
  • Tim Nanof, MSW, is director of ASHA health care policy and advocacy. tnanof@asha.org
    Tim Nanof, MSW, is director of ASHA health care policy and advocacy. tnanof@asha.org×
  • Ingrida Lusis is director of ASHA federal and political advocacy. ilusis@asha.org
    Ingrida Lusis is director of ASHA federal and political advocacy. ilusis@asha.org×
  • Janet Deppe, MS, CCC-SLP, is director of ASHA state advocacy. jdeppe@asha.org
    Janet Deppe, MS, CCC-SLP, is director of ASHA state advocacy. jdeppe@asha.org×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   June 01, 2017
The American Health Care Act: What’s Next?
The ASHA Leader, June 2017, Vol. 22, 24-25. doi:10.1044/leader.PA1.22062017.24
The ASHA Leader, June 2017, Vol. 22, 24-25. doi:10.1044/leader.PA1.22062017.24
As the U.S. Senate considers health care legislation passed by the House of Representatives in May, the future of American health care remains unclear.
The U.S. Senate has indicated it will not pass the bill—the American Health Care Act (AHCA), which seeks to overturn the Patient Protection and Affordable Care Act (ACA)—in its current form. The Senate could create legislation that may be significantly different from the House bill, requiring compromise between the two bodies and another vote in the House. As of press time, Republican leaders in the Senate had not discussed any timeline or process to address AHCA.
ASHA will continue its advocacy on issues of concern in the Senate. Although ASHA has not taken a position on the AHCA, the association is actively engaged with Congress to address specific areas of concern, such as the potential negative impact of Medicaid block grants and the importance of maintaining essential health benefits. Earlier in the year—and in response to legislative proposals—ASHA issued seven health care policy positions to guide advocacy.
For now, the ACA remains the law of the land—but federal legislation is not the only way to influence health care policy. Changes in state laws and regulations, federal regulations, and federal funding policies could affect further health care reform.
For ASHA and its members, those possible attempts to change how the ACA is carried out may mean the opportunity for advocacy on issues that affect ASHA members and their clients and patients.
ASHA encourages members to be aware of legislative, regulatory and state-level proposals that could affect ACA coverage policies. State changes especially require members’ local vigilance and action.

ASHA is actively engaged with Congress to address specific areas of concern, such as the potential negative impact of Medicaid block grants and the importance of maintaining essential health benefits.

Legislative reform
Leaders in the Senate have made it clear that they plan to be deliberative in developing their version of health care reform, and are waiting on the Congressional Budget Office report on the cost of the legislation. Even if the Senate develops and passes its own health care reform legislation, House and Senate leaders would need to negotiate both bills through a conference committee to develop a compromise. Because House majority leaders had difficulty getting its more moderate and fiscally conservative members to agree on its version of the AHCA, any major changes to the House bill could jeopardize its support.
Regulatory reform
Even in the absence of health care reform legislation, the ACA can be transformed through the regulatory process. The Trump administration has broad leeway in carrying out certain federal regulations—such as not enforcing the individual mandate, for example—that would fundamentally change the way the ACA is implemented.
Another—more likely—option could be to rescind or to not enforce certain selected provisions, with dramatic impact on health care policy. For example, the mandate that requires people to purchase qualifying health care coverage could be defunded, meaning penalties could not be assessed for failing to enroll.
Another possibility—of great concern to ASHA—is action to rescind or not enforce the regulations on patient visit limits. These regulations, which went into effect in January, require health plans to have separate visit allowances for habilitation visits and rehabilitation visits. Insurers may not combine the two types of visits into a single category under current regulations.
State-level reform
The lack of sweeping health care reform and the possibility of selective enforcement of regulations creates a policy vacuum likely to be filled by the states. State legislators and regulators will have increasing influence as the health reform process grinds on. In addition, the Trump administration and Congress have signaled their intent to allow states greater authority and flexibility over health care policy.
This strategy may provide more opportunities for local advocacy, so members need to be aware of and ready to respond to changes and threats to access to care, reimbursement and service delivery. Issues such as Medicaid funding and eligibility are likely to play out in the states, as are coverage of habilitation services and subsidies for health care coverage.
Governors—individually and collectively through the National Governors Association—are extremely influential, and their clout in the health care debate is only expected to grow. The same can also be said of state legislatures and insurance commissioners. ASHA is actively working with these groups and with their national organizations.
Change is coming, but what that change will look like is unclear. ASHA is strenuously advocating to protect access to care and coverage of speech-language and hearing services, and is preparing for any challenges and opportunities that might arise.
Members are encouraged to continue their vigilance and be prepared to take action with these ASHA resources:
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June 2017
Volume 22, Issue 6