Nov 01, 2016 | By Kim
Buckey
As the election
draws nearer and more controversy surrounds the Affordable Care Act, we take a
look at what might happen to the health law once a new president assumes his or
her role as commander-in-chief. (Photo: iStock)
When the 45th
president of the United States takes the oath of office on January 20, 2017,
the Affordable Care Act will
face its first test under a new commander-in-chief.
Beyond Obama
Democratic
presidential nominee Hillary Clinton and
Republican presidential nominee Donald Trump have very
different approaches to the future of health care reform, with Clinton
promising to “protect” the ACA, and Trump calling for a full repeal.
The truth for
both sides is somewhere in between.
Whether the
executive branch remains blue or turns red, the ACA will have had nearly seven
years to mature since it was signed into law.
Trump repeated
his call to repeal the Affordable Care Act and Clinton spoke up for wellness.
A full repeal
is not realistic for many reasons — perhaps the most obvious being that several
provisions are popular with both employers and the public and enjoy bipartisan
support.
And while each
candidate has a vision for the future of health care, the fate of that vision
and of the ACA itself will depend heavily on the partisan makeup of Congress.
The ACA under Trump
While Trump's
promise to repeal the ACA and
replace it with “something terrific” is not realistic, replacing significant
pieces is possible if Trump is elected and the House and Senate remain under
Republican control. Trump's health care plan falls into three buckets:
- More choice, lower costs, greater
flexibility — Expand access to health spending accounts to inspire
movement toward consumer-directed health plans (CDHPs). This also supports
greater health insurance portability, which includes subsidies for
purchase of health insurance, private exchange options, a repeal of the
individual and employee mandates and a change to the definition of a
full-time employee. A major point to consider is the tax treatment of
employer-sponsored insurance. Currently, the value of benefits is excluded
from income. Trump is calling for a cap on this exclusion as an
alternative to the Cadillac Tax (which he says he’ll repeal). This also
supports insurers operating across state lines and pooling for small
businesses.
- Protecting and strengthening
coverage options for all Americans — Supports insurance market reform,
including many provisions already established in the ACA, such as no pre-existing
condition exclusions, allowing children on parents’ plan through age 26,
no lifetime limitations on coverage, no rescissions, guaranteed
renewability and continuing coverage protections. This supports additional
state funding for high-risk pools and a one-time open enrollment, which,
as long as consumers maintain continuous health insurance coverage
throughout their lives, would prohibit an insurer from re-rating its plan
based on medical condition.
- Protecting Medicare and Medicaid
for future generations — Advocates modernizing a premium support model for
Medicare that would guarantee every enrollee an income-adjusted
contribution toward a plan of their choice, with catastrophic protection.
This also imposes no changes for persons 55 or older.
The ACA under Clinton
There are five
key elements of Clinton's health care plan that support employer-sponsored
insurance (ESI) and do not support a single-payer system, a solution her
opponent in the primaries, Bernie Sanders, made a central part of his campaign.
- Expand access — Proposes a
government plan option for coverage on each state's public exchange, which
would compete against commercial plans. Also wants to allow individuals to
opt into Medicare at age 55 and expand primary care funding at federally
qualified health centers from $20 million to $40 million.
- “Protect” the ACA —
Opposes any efforts to cut back or repeal the ACA. To offset rising
premiums on the public exchange, suggests subsidy increases. Would work
with governors in the 19 states who have not taken up ACA Medicaid
expansion to change their minds.
- Control health care costs —
Believes that workers should share in the slower growth of national health
care spending through lower premiums, deductibles and copays, but seeks to
limit out-of-pocket costs for the insured and to enhance government
authority to reject “excessive” premium increases.
- Reduce prescription drug costs —
Suggests limits on out-of-pocket costs for prescription drugs,
specifically through government programs like the exchanges, Medicare and
Medicaid.
- Support “value” in health care —
Supports initiatives to promote value-driven health care programs
established by President Obama, including the Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA), the Center for Medicare &
Medicaid Innovation (CMMI) and accountable care organizations (ACOs).
Uncertainty puts benefits communication at forefront
Potential
revisions to the ACA, whether they are incremental or substantial, will require
strategic, thoughtful benefits communications to prepare plan participants for
the impact on their plans and, ultimately, on them and their families.
We already know
from multiple studies and surveys that plan participants do not have a good
grasp of how health insurance works and, in fact, don't think about their
coverage until they actually have to use it. Anything brokers and their clients
can do to provide context for potential plan design changes will go a long way
toward increasing acceptance and understanding of those changes when the time
comes.
Whether Clinton
or Trump is elected, companies that employ or outsource knowledgeable benefits
communication expertise will be better equipped to navigate changes to the ACA
and have the best chance of engaging and retaining a productive workforce.
ESI future looks bright
With neither
candidate proposing a viable replacement, the future of employer-based
insurance is strong. The timeline for a transition to a single-payer system (or
Trump's proposal of portable and non-employer binding coverage) is likely decades
rather than years away, and employers will be reluctant to eliminate any
program that will give them an edge in recruiting and retaining talent.
Congress and
the current administration also see the value in ESI, a perspective which
contributed to postponement of the Cadillac Tax to 2020. Clearly, the
government does not want to push employers into decreasing or dropping coverage
entirely.
That said, the
ESI market will continue to evolve from both a product and service perspective
in response to employer and employee needs and changing regulations.
Full repeal is not an option
The political
and economic backlash from suddenly ending health care coverage for an
estimated 20 million Americans would be too great for full repeal to truly be
an option.
Insurers have
invested millions of dollars in systems to support ACA environments and would
incur additional costs to retool or replace what they’ve put in place.
Employers would
face similar challenges, nullifying in-house and consulting investments to comply
with new, revised or disbanded ACA provisions.
While many of
Trump's provisions are similar to what is already included in the ACA, there
are operational differences that rely on a principle of conservative
governance.
As an example,
while ACA subsidies increase as premiums increase, Trump's plan calls for
subsidies to remain flat, encouraging competition as a way to drive down
premiums and make insurance more affordable.
Promoting
private exchange options in addition to the public exchange could, in the
spirit of competition, bring down prices. Neither of those outcomes will occur,
of course, unless changes are made that bring insurers back into the
marketplace, after the exodus we’ve seen in past months.
A recurrence of
the full-blown ACA debate of 2009-2010 is not realistic. Instead, new health
care legislation will emerge in the context of incremental changes that might
even contain some elements of bipartisanship.
http://www.benefitspro.com/2016/11/01/how-the-aca-will-look-under-trump-or-clinton?kw=How+the+ACA+will+look+under+Trump+or+Clinton&et=editorial&bu=BenefitsPRO&cn=20161106&src=EMC-Email_editorial&pt=Benefits+Weekend+PRO&page_all=1
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