After Monday night's collapse of the latest GOP plan to repeal and replace Obamacare, disarray in Congress and uncertainty in the healthcare industry are the only foreseeable results in the near term.
Senate Majority Leader Mitch McConnell vows now to hold a vote on a "clean" repeal bill that, effective two years from now, would repeal key provisions, defund the Affordable Care Act exchanges, eliminate subsidies for lower income individuals' policies and remove penalties for individuals and employers who don't comply with Obamacare's coverage mandates. ACA's expansion of Medicaid would be gone and over the next two years, the Congress would try to enact a replacement.
In the meantime, the segment of the healthcare industry likely to suffer most is hospitals. Mizuho Securities USA Inc. analyst Sheryl Skolnick has long warned that the GOP plans to repeal and replace the ACA were bad for hospitals because they would have increased the ranks of uninsured and would likely leave in place fees and funding cuts on hospitals and others to help cover ACA's costs, which include $155 billion in cuts to hospital reimbursements and a host of regulations, taxes and fees on managed care. Over the next 10 years those pay-fors are expected to raise $1 trillion.
"The uncertainty factor did NOT die" with the Senate bill, she wrote in a note Tuesday, "but rather increases, with an outcome that could be even worse for hospitals and Medicaid plans (never mind the uninsured) in the near term."
Hospital stocks likely to be bogged down by the uncertainty are Community Health Systems Inc. (CYH - Get Report) , HCA Holdings Inc. (HCA - Get Report) , LifePoint Health Inc. (LPNT) , Quorum Health Corp, (QHC - Get Report) , Tenet Healthcare Corp. (THC - Get Report) .
"In our view, this uncertainty is even worse than passage of a really bad bill for the group - until we know for sure that the status quo prevails and will be funded, the threat is sure to keep the hospitals range bound and the risks high," she wrote.
Delaying a vote on a replacement bill would allow no certainty to come the sector's way until after the 2018 midterm elections. Stability may not even come then, as Congress could extend that deadline, perhaps repeatedly.
"This morass of uncertainty could go on for a very long time—with a chilling effect on exchange-covered lives, likely leading to pool shrinkage and even more adverse selection," Skolnick wrote.
In the meantime, hospital and other health sector stocks underperform their potential. "Uncertainty is really bad for companies—especially as we get close to 3Q and forward-year strategic planning," she said. "A full 'repeal' without replace runs the risk, in our view, that we could find ourselves in 2019 with no replacement and a split Congress that can't agree on a replacement or, worse, can't even agree on a delay in the repeal."
For the hospitals, the likelihood of a repeal-only bill, keeps the stocks in their trading range and more at risk for adverse consequences from deteriorating payer mix, she said.
McConnell's quest for a clean repeal bill also looks destined for failure. Already Republican moderates Sen. Lisa Murkowski of Alaska, Susan Collins of Maine and Shelley Moore Capito of West Virginia, have said they will oppose a repeal-only move and McConnell can afford to lose only two GOP members and still pass the bill without Democratic support.
For President Donald Trump, the only goal seems to be simply passing any type of Obamacare repeal--partial or full repeal, with or without a replacement plan doesn't matter. Trump is now vowing to "let Obamacare die" on its own, which he says will bring Democrats to the negotiating table.
Brian Gardner, analyst at Keefe, Bruyette & Woods Inc., shares Skolnick's belief that ACA repeal efforts may linger indefinitely.
"The Republican base will be unsatisfied unless there is a clear vote on repealing Obamacare," he wrote Tuesday. "We expect that vote will similarly fail but that might excuse the Republican leadership from further votes and debate over health care and will allow lawmakers to turn to tax legislation."
If by some chance the repeal bill actually passes, Gardner predicted Congress "will repeatedly kick the can down the road and continually delay the repeal of Obamacare as a replacement will likely prove to be elusive."
To break the likely logjam, Sen. Joe Manchin, D-W.V., has reached to to fellow former governors who now hold Senate seats, in hopes that the bipartisan groups can discuss reform in a more non-partisan manner.
Republicans in the group include Lamar Alexander of Tennessee, Mike Rounds of South Dakaota, James Risch of Idaho and John Hoeven.of North Dakota. Democrats thare reportedly Virginia's Mark Warner and Tim Kaine, Tom Carper of Delaware, Jeanne Shaheen of New Hampshire, and Maggie Hassan of New Hampshire.
Manchin also hopes that the governors, with their knowledge of state Medicaid markets can offer health coverage solutions that members from both parties will find acceptable.
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