During a marathon voting session Wednesday, Senate Republicans voted down legislation meant to save provisions within the Affordable Care Act that protect women's healthcare services and coverage for people with pre-existing conditions.
Another amendment aimed to protect the provision that allows young adults up to age 26 to stay on their parents' health insurance plans.
Those amendments, brought forth by Democrats in a largely symbolic gesture, were tied to a budget resolution passed in a 51-48 vote, which kicks off the process of dismantling the ACA.
While the up-till-26 provision was rejected as well, insiders say they wouldn't be surprised if it showed up in the eagerly anticipated replacement plan that seemingly more Republicans hope will continue to provide coverage to as many as 30 million people who gained insurance through President Barack Obama's signature healthcare law.
The up-to-26 provision successfully reduced the uninsured rate among young adults and is widely supported by Americans, no matter which way they lean politically. At the same time, keeping the provision could further destabilize the individual insurance market and lead to higher premiums.
“The same problem that the ACA has had with an unbalanced risk pool from this particular provision, (Republicans) are inheriting it,” said Joe Antos, a health policy expert at the right-leaning American Enterprise Institute.
Republicans leaders, including President-elect Donald Trump, have already voiced support for the provision. Several Republican replacement plans, including House Speaker Paul Ryan's blueprint, include the rule. That means it's likely to survive under the new administration, Antos said.
But that doesn't mean it should, he said.
One of the major issues that has plagued the individual insurance market, including the ACA exchanges, is the lack of young people who have enrolled. Enrollees typically skew older, which has created an unbalanced pool that has led insurers to hike premiums. Despite marketing efforts by the Obama administration, young people haven't showed up to enroll. The latest CMS data on the exchange enrollment shows no improvement.
Antos said it's likely because young people are staying on their parents' health insurance plans. But if that option weren't available, young people would enroll in the individual market and premiums would have the chance to stabilize. Parents would likely help out the young adults that couldn't afford the plans on their own, as Antos did for his own kids, he said.
“There were undoubtedly some (young adults) that would have gone to the exchanges,” said Dr. David Blumenthal, president of the Commonwealth Fund. But allowing them to stay on their parents' plans was efficient and reduced the federal government's cost of subsidies they would have had to pay to support the young, low-income adults, he said.
It's also possible that young people would have chosen to remain uninsured instead of enrolling in the individual market plans.
In total, 6.1 million young adults ages 19 to 25 gained insurance because of the ACA, according to 2016 federal data. And 2.3 million young adults who gained coverage from 2010 through the start of open enrollment in 2013 did so because the up-to-26 provision.
As of now, Republican lawmakers have shed little light on what a final replacement plan will look like, and there are mixed messages about when such a plan will be revealed.
The budget reconciliation bill, which the House is expected to take up Friday, affects only the financial aspects of the ACA, so there will be no clues in that bill to what of the ACA will remain.
But the vote was an attempt by Democrats to get Republican lawmakers to “go on the record” that they are committed to keeping the provision that has benefited young adults, said Thomas Huelskoetter, policy analyst at the liberal Center for American Progress.
The future of the provision “doesn't seem to be in imminent danger right now, but it's still too early to call it safe” he said.
