- Since the Presidential election of Donald J. Trump, a number of differing viewpoints came out emphasizing how the Patient Protection and Affordable Care Act will be impacted. For the last several years, the Republican Party has attempted to repeal the Affordable Care Act and replace it with another healthcare coverage plan.
Joel Ario and Chiquita Brooks-LaSure, co-managing directors of Manatt Health, released a statement regarding the future of the Affordable Care Act now that Donald Trump has secured the presidency.
“While the Presidential election can hardly be described solely as a referendum on the Affordable Care Act or health care policy in general, it nevertheless will likely have a huge impact on both, especially with President-elect Trump featuring the repeal and replacement of the ACA as a core message of his campaign. When he takes office we can expect the new President to begin to work with the Republican-controlled Congress to dismantle the ACA,” Ario and Brooks-LaSure stated.
Since Congress does not have the 60 votes necessary from the Republican side to repeal the Affordable Care Act, more short-term solutions will likely be implemented such as using the budget reconciliation process to halt aspects of the ACA.
“The process of dismantling the ACA will be complicated and not immediate. With Republicans short of the 60 Senate votes needed to end a filibuster, the path to dismantling the ACA will focus on the budget reconciliation process, which only requires a majority vote. In other words, Senate Democrats can block the wholesale repeal of the law, though there will be pressure on Democrats from more conservative states on closure votes depending on the issue,” continued the Manatt Health representatives.
“Reconciliation will take time and while Congress is wrestling with that challenge, the new Administration will have other administrative levers to use, including state waivers to change Medicaid and Marketplace policy, as well as reversing executive orders and recently-promulgated rules.”
One potential replacement plan for the Affordable Care Act was put forth this past summer by Congressman Pete Sessions (R. Texas) and Senator Bill Cassidy (R. La.). The replacement plan is called the Healthcare Accessibility, Empowerment, and Liberty Act of 2016 and is not as comprehensive or detailed as the Affordable Care Act, the Health Affairs publication reported.
One interesting aspect of this proposed legislation is that it does not seek to repeal the Affordable Care Act in its entirety. The portions of the Affordable Care Act the legislation seeks to repeal include the individual mandate and the employer mandates. Other consumer protections are also scrapped from the ACA within the Healthcare Accessibility, Empowerment, and Liberty Act.
Some of the changes from the proposed legislation would include reforms of income-based premium tax subsidies, Medicare, and general tax increases. This particular replacement plan does not align with some typical GOP positions when it comes to healthcare coverage such as the ability to sell health plans across state lines. In fact, the proposal positions full control for states to regulate insurance within their borders.
The proposed legislation also does not promote health savings accounts. Also, the Sessions and Cassidy replacement plan positions a per-capita cap on Medicaid funding in a way that will “ease the transition from the current program,” Health Affairs reports.
There are particular details of the Healthcare Accessibility, Empowerment, and Liberty Act that may even expand healthcare coverage across the country such as automatic enrollment in very basic insurance plans by the states.
Additionally, the proposed legislation would create penalties for consumers who do not keep continuous coverage and offer more low-cost, low-value health plans. Families and individuals who currently have income-based tax subsidies as well as Medicaid coverage due to state expansion efforts will be grandfathered in to keep these health insurance options.
The publication Vox reported how the Healthcare Accessibility, Empowerment, and Liberty Act would provide more generous tax subsidies for older Americans who have larger premiums from their health plans. Additionally, the proposed legislation does not eliminate the pre-existing condition clause of the Affordable Care Act. However, payers would be able to charge higher rates to those with serious and costly medical conditions if they do not keep continuous healthcare coverage.
One interesting way that this proposed legislation could improve the function of the health insurance exchanges is through automatic enrollment of uninsured individuals by states in low-cost health plans. As such, young adults and others without insurance would need to opt-out of the health plans if they don’t want insurance. This could lead more young adults to automatically enter the market and potentially offset the costs of more expensive care among the older and sicker population.
While the future for the Affordable Care Act may be uncertain, once certainty for payers and providers is the continued efforts to reform the healthcare industry and reduce rising medical costs over the coming years.