The uncertainty of health-care reform and the affordable care act: the health-care reform debate could have a substantial impact on state and local governments because of their dual roles in providing health-care services to constituents and health-care benefits to public employees.

• Author: Williams, Kathryn
• Position: FEDERAL FOCUS

With the 115th Congress and the Trump administration having gotten through their first 100 days, the question remains whether Republican leaders will be able to achieve one of their signature promises of the 2016 election--repealing and replacing the 2010 Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA). In general, it is not uncommon for a new administration and Congress to experience a slow start, especially on priorities where cooperation and coordination are needed from both ends of Pennsylvania Avenue. But the challenge becomes even more acute when it involves repealing and replacing a health-care law like the ACA, which is the most significant health policy since the creation of programs in the 1960s like Medicare and Medicaid.

The fact that one party controls both the White House and Congress might lead some to believe that it should be fairly simple to enact or repeal legislation. But the age-old maxim that usually holds true for federal legislation certainly applies here--the devil is in the details. And it is those details that proved to be insurmountable for Republicans in their March 2017 attempt to repeal and replace the ACA.

The setback should not be seen as a sign that health-care reform is dead. It's just on hold. In the days after the March 24 vote on a reform plan was unexpectedly cancelled, House Speaker Paul Ryan (R-WI) said the House still hopes to tackle health-care reform, but he didn't provide a specific plan or timeline. This article will discuss why the health-care debate is important for state and local governments, followed by a brief review of the current status of the health-care reform efforts that could set the stage for other major issues in the near future, like comprehensive tax reform.

WHY IT MATTERS

The ongoing debate surrounding health-care reform, and any potential outcome, could have a substantial impact on state and local governments because of their dual roles in providing health-care services to constituents and health-care benefits to public employees.

As a provider of services, state and local governments spent $20 billion in 2013 to provide health care for low-income, uninsured, or underinsured residents--usually unreimbursed. Further, county governments invest a total of $83 billion a year in community health systems; they support 976 hospitals and more than 1,900 local public health departments. The health-care debate has become increasingly important to GFOA's agenda in recent years because health care is the fastest-growing portion of state and local government budgets. In 2006, GFOA adopted a policy statement expressing support for health-care reform initiatives that would expand access to quality care and control the growth of health-care costs. GFOA policy encourages a federal approach that includes: expanded health-care...