NOW THAT we will have Donald Trump as president and the GOP retaining control of Congress, all bets are off on the future of the Affordable Care Act. Trump may decide to hand over the health insurance reform portfolio to Speaker Paul Ryan, who along with the House leadership in July published a blueprint for how they would like to repeal and replace the ACA. Trump assailed the ACA during the campaign, saying he would abolish it, but since then he’s backpedaled on how far he wants to go.
The big unknown
The question is how far the appetite will go for an outright appeal of the ACA, as it would be a major market sruption, particularly for the millions of people who now have coverage through their jobs or health insurance exchanges. Any attempts to repeal the ACA will also be met with stiff resistance from Democrats, who could mount a filibuster to keep legislation from advancing. However, if the changes are embedded into the budget, the filibuster
rules would not apply and the Republicans could push it through on a simple majority vote. Finally, because an outright elimination would strand millions of Americans without health insurance, it is unlikely that Republicans
would try to repeal it without a replacement.
The best strategy for our clients now is to stay the course and continuing complying with the law. No changes will be immediate and we will keep you informed of changes here as they occur.
- Eliminating public health insurance exchanges.
- Setting up free health savings accounts for people with high-deductible insurance plans.
- Setting up state-based high-risk pools for people with medical conditions that make it hard to get coverage on their own.
- Allowing insurers to sell coverage across state lines to “boost competition and drive down prices.” This idea may not yield the benefits some think as insurers would have to set up doctors networks in other states.
- Eliminating the “Cadillac” tax on high-priced health plans.
Trump has not specifically mentioned the employer mandate. Some observers have said that if the ACA is repealed he could retain the mandate, but at the highest threshold of 100 full-time employees – and not the current 50.
The House Plan
- Expanding the use of health savings accounts linked to high deductible health plans.
- Supporting coverage portability, whereby individuals would purchase a health care plan that they can take with them from job to job. The plan would include a universal, advanceable and refundable tax credit.
- Only allowing employees to pay for premiums on a pre-tax basis up to a certain level (meaning that above a certain premium level, they would have to pay for the premium using income that’s already been taxed).
- Allowing small businesses to pool together to buy health insurance.
- Allowing consumers to buy insurance across state lines.
- Preserving employee wellness programs.
- To tackle costs, the plan includes reforming medical liability laws to reduce large awards for medical malpractice.