There may or may not be a vote on the fate of Obamacare on Friday.
But make no mistake. Even if lawmakers wind up failing in their bid to repeal the Affordable Care Act, the future of the seven-year-old health care law is still highly uncertain.
That’s because many big insurers have already pulled out of many state exchanges, which has blunted the impact of the law.
Humana said last month it would exit all of the ACA exchanges in 2018, regardless of what happens to Obamacare.
The CEO of Aetna told The Wall Street Journal last month that Obamacare was in a “death spiral.” Aetna and Humana had planned to merge but the two pulled the plug earlier this year after a federal judge blocked it due to antitrust concerns.
Cigna said in November — just days before the election — that it was not planning to expand its ACA business this year.
Anthem, which had hoped to merge with Cigna before that deal was also shot down in court, said last month it too was unsure of whether it would participate in the ACA exchanges in 2018.
What’s more, Anthem CEO Joseph Swedish recently wrote a letter to two Republican House committee leaders in which he expressed support for parts of the American Health Care Act, the GOP bill that some have dubbed Trumpcare.
And UnitedHealth said last April, back when Hillary Clinton was still leading Donald Trump in many presidential polls, that it was planning to get out of most ACA insurance exchanges by this year.
The five big insurers have found it difficult to make the economics work for the ACA exchanges.
When UnitedHealth announced its intention to exit Obamacare last year, CEO Stephen Hemsley said the markets for the exchanges were relatively small and have higher risks for the company.
Hemsley added that UnitedHealth could not serve these exchanges on an “effective and sustained basis.” UnitedHealth has lost more than $1 billion on its ACA business.
But two smaller insurers, Molina and Centene, stand to lose (or gain) the most from a future with Obamacare.
Those two companies have actually profited from the ACA, thanks to their focus on Medicaid — the government program that expanded under the ACA.
They are the exception though, not the rule. While Molina and Centene would benefit if Obamacare lives to see another day, the other major insurers have already effectively said that the ACA is not a viable business.