With the recent election spurring a “repeal and replace” mantra for the Affordable Care Act, opinions and speculation now circle around how likely, desirable or even possible that may be. There’s simply no telling what’s going to happen, especially with key cabinet positions and transition plans for the new administration still in flux. Even among those opposing the ACA, there are significant differences of opinion.
Tinkering with the plan isn’t as easy as it may sound, experts agree. Many incentives and disincentives are in place within the current structure (even aside from the ACA) that reflect a delicate balance. Making changes in one area creates ripples elsewhere. There are many stakeholders in the $3-trillion healthcare industry, which has been integrating ACA law into the fabric of its operations for the last six years.
The ACA has both popular and unpopular parts and they are intertwined. President-elect Donald Trump has said he may keep the rule that protects people with pre-existing conditions – a very popular feature of the plan. However, some argue that without the individual mandate, very unpopular among ACA opponents, the pre-existing condition protection doesn’t work.
Act quickly or proceed with caution?
Americans have indicated that they consider healthcare to be the number one concern for a new administration to address. Some Trump advisors believe a rapid repeal is a campaign promise that must be kept and that they have a mandate to repeal the ACA without having settled on an alternative. The president-elect and those around him have sent conflicting signals as to whether they’ll move quickly on healthcare in early 2017.
While a full, immediate ACA repeal directly by a president isn’t technically possible, action to dismantle pieces of the ACA can be made through a Congressional process called “budget reconciliation,” which allows for expedited consideration of certain taxes, spending and debt limit legislation. This process is not subject to filibuster, which means the actions are easier to pass in Congress.
Another option is to repeal the ACA through the same legislative wrangling and compromise that built it, develop an alternative plan during 2017, and then defer its implementation. This timing reflects the reality that insurers must submit 2018 premium rates to regulatory bodies for approval in the spring of 2017. Setting realistic, defensible rates in the industry at that time without being able to estimate 2018 risk and reward would be practically impossible.
Some observers say the political ramifications of mostly or completely overturning the ACA are simply too great and that its opponents will have to settle for tweaking it more to their liking. Whatever happens, healthcare will continue to be a hot-button issue for Americans as long as costs continue to rise.
In these unsettled times, it’s wise to be prepared for as much change as possible. ABILITY helps with easy-to-use applications and up-to-date industry information. Visit the ABILITY Resource Center.