How Presidential Election will Impact the Affordable Care Act

July 29, 2016 - For months now, the media has been broadcasting 24 hours per day, seven days a week news related to the upcoming presidential election. Many have postulated on how the nation will be impacted if either the Republican Party or the Democratic Party take hold of the White House. How will the presidential election affect healthcare policy and the Affordable Care Act? Below we outline the two sides to the equation.

GOP replacement plan and repeal of the ACA

The Republican Party has not kept it a secret that many of its representatives are looking to repeal the Patient Protection and Affordable Care Act. For instance, at the end of 2015, the GOP attempted to repeal huge sections of the Affordable Care Act. The bill passed both the Senate and the House of Representatives but was vetoed by President Barack Obama.

In June 2016, House Speaker Paul Ryan released a replacement plan meant to take the place of the Affordable Care Act. This plan focuses on implementing health savings accounts, eliminating Medicaid expansion, and selling health plans across state borders.

Additionally, the GOP is seeking to increase the eligibility age for Medicare coverage to 67 years of age by the year 2020. However, this replacement plan lacked the financial details necessary to better understand how the plan could possibly replace the Affordable Care Act.

Essentially, the replacement plan lacks any mention of how the 20+ million people who have gained health insurance since the ACA took hold would remain covered under their health plans.

“The proposal introduced by Speaker Ryan is nothing more than vague and recycled ideas to take health insurance away from millions and increase costs for seniors and hard working families,” White House Assistant Press Secretary Katie Hill told Kaiser Health News.

Nonetheless, there is one positive in the replacement plan, which is the assurance that people with pre-existing conditions would be able to remain insured. On the other side of the equation, Democratic nominee and former Secretary of State Hillary Clinton is looking to build upon the Affordable Care Act instead of repealing it.

Democratic presidential nominee’s plan to expand the ACA

Some of the key strategies that former First Lady and Secretary of State Hillary Clinton is looking to accomplish when it comes to healthcare reform include expanding the Affordable Care Act and reducing out-of-pocket costs for consumers, according to her campaign website.

Additionally, with the costs of prescription drugs skyrocketing from a 2.5 increase in 2013 to a staggering 12.6 percent rise in spending growth rate, Clinton is looking to move the pharmaceutical industry to decrease prescription drug costs for working families and seniors. Along with these goals, Clinton is looking to incentivize the rest of the states who haven’t expanded their Medicaid programs to broaden this coverage for its low-income families and citizens.

Expert opinion on the presidential election’s healthcare reform impact

Dr. Josh Luke, Professor at the University of Southern California and former Hospital CEO, spoke with HealthPayerIntelligence.com about some of the potential impacts that the presidential election will have on the Affordable Care Act and healthcare reform.

When asked what impact the GOP or the Democratic Party would have on the ACA, Luke responded, “Obviously, there would be less to talk about and less activity if Hillary Clinton wins the White House. Democrats would continue to push the Affordable Care Act and claim victory. I think tactically what you will see if the Democrats take the White House is a push to revive and tweak the exchanges and claim it was always successful but now they’re even better even though there is evidence to suggest that that program is not the strongest.”

Luke also mentioned that there would be more push to increase healthcare spending by the federal government if the Democrats take the White House.

“Also, I think you’re going to see a huge push from the White House to justify additional spending that’s been largely in question whether it was justified dollars allocated towards healthcare and supporting this mandate,” Luke added.

When it comes to the Republican Party’s position on healthcare reform, Luke explained that many who ran for President such as Senator Ted Cruz have been looking to repeal the Affordable Care Act. However, few experts have actually supported the idea that the ACA could be simply undone, says Luke.

“There’s not many experts in D.C. that think the ACA can be undone,” Luke pointed out. “When you talk about value-based care and patient-centered care, I don’t know that you’ll find many people that think the focus should be taken off of the patient and put back on strictly reimbursing on a fee-for-service basis.”

“To date, Trump’s healthcare plan has been very vague. What you expect to see from Donald Trump, he has wanted to enhance privatization of healthcare, which is going to also create additional competition and similar to what you’ve seen in the Medicare Advantage space in recent years.”

“Whereas one product may have only a $1.00 copay for generic meds, the other might charge $5.00 for generic meds and have vision benefits. I think you’ll see a real push for privatization and healthy competition from the Trump White House,” Luke continued. “I also think you’ll see an impact on the individual mandate that everyone must have insurance. If the GOP takes the White House, they would have to undo small parts of the ACA and claim victory that they undid it.”

Essentially, the USC professor believes that the GOP could undo small sections of the ACA while keeping at least 70 percent of it in place and will likely claim victory over the minor eliminations.

“I would think the easy targets are the state exchanges being undone and converted to the private sector and also the mandate that every American needs to have healthcare benefits or otherwise pay a penalty,” Luke added.

When asked what would occur to the health insurance industry if the ACA was repealed and replaced, Luke answered by discussing some of the key challenges.

“It would be chaotic. There’s no doubt about it,” he explained. “I think the federal government would have to come up with a lot of dollars to replenish the Medicare funds if we were to revert back to a fee-for-service approach. I think the American public would have a lot of questions about how they can expect to be cared for and live in a healthy manner without being sent to a hospital or having to actually go visit their doctor’s office, which is how doctors were paid for during the fee-for-service era.”

“There’s truly desire and a cultural shift towards living more healthy after six years of talking about population health that when all the resources are pulled out from under your feet to help you live a more healthy lifestyle and you revert back to a manner when you can only get input on your health when you go to the hospital or visit a doctor, I think you’re going to have a general public that is not content.”

Dr. Luke also discussed how it won’t matter who wins the White House when it comes to the rise in healthcare costs across the board. While there has been somewhat of a stabilization in the growth rate, healthcare spending is still slowly rising every year and is predicted to only increase in the growth rate over the coming years.

Luke says that whoever wins the presidency will need to address the rising costs of healthcare spending, especially since there are double-digit increases in the premiums among health plans sold on the exchanges.

As for anything payers can do on the exchanges to avoid monetary losses and having to drop out of the exchanges, Luke said, “There may not be enough time for that among payers committed to marching forward. There’s going to need to be financial relief infused for those who are committing to stay and even that may not be enough. You already see lawsuits out there about shortfalls on payments that were projected so it’s going to be a very interesting 18 months as it relates to that.”

Dig Deeper:

Democratic Party’s Predictions for the Affordable Care Act

Why GOP Should Hold Off on Replacing the Affordable Care Act