In the early morning of Friday, July 28th, Senator John McCain (R-AZ) ended the latest Republican-led efforts to “repeal and replace” the Affordable Care Act (ACA) by joining two other Republican Senators and every Senate Democrat in voting against a “skinny” repeal measure. Coming on the heels of two other failed votes in the Senate, any efforts for Republicans to deliver on the signature Republican campaign promise of repealing and replacing the ACA appear to be on hold.

If you’re a fan of a political theatre or just want more political context on the Senate’s failed effort check out a great summary here and here.

However, this failure does not mean that there will be no further action in Congress or in the states regarding the ACA or other elements of healthcare policy. The individual market, served via the health insurance marketplaces, still faces serious challenges including regulatory uncertainty coupled with, perhaps even causing, rising premiums and fewer insurers offering coverage.

Lawmakers in Congress have already moved on from "repeal and replace" efforts and some are currently exploring paths to stabilize individual markets. Absent a move from Congress, stakeholders will be closely monitoring HHS for any regulatory action that may impact this market.

While the ACA has garnered the most attention in the press, several other significant events have taken place:

• The Department of Justice cracked down on fraudulent opioid treatments resulting in 412 people charged, including 56 physicians, for defrauding the federal government of $1.3 billion.
• Partisan politics stalled efforts in the House of Representatives to re-authorize the Department of Veterans Affairs Veterans Choice Program. Ultimately the measure was passed by the House and the Senate approved the measure on August 1st. This program, utilizing URAC-accredited contractors, allows veterans to access care in their community when the wait or distance to a VA center is too great.
• New Hampshire House Bill 455, which would prohibit a PBM from requiring accreditation, was enacted without the Governor’s signature. As the bill has a 10 month sunset provision, this is sure to set up a fierce debate in 2018 when the measure must be reauthorized.
• The National Association of Insurance Commissioners (NAIC) continues its work to update its “PBM Model Act.” In recent discussions, regulators adopted consumer notification requirements largely mirroring URAC’s standards for consumer notification.

What’s on the horizon for the remainder of the year? Expect the long slow march of MACRA implementation to continue (URAC comments will be out by the end of August) as well as CMS-led efforts to strengthen Medicare Advantage. A continued focus at all levels of government on tackling the opioid crisis is sure to continue.

Perhaps the move most anticipated is potential action by Congress, the FDA, or state governments to corral out-of-control drug prices.

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