With a major changeover in political leadership effective January 2017, a cloud of uncertainty hangs over the fate of healthcare, which represents a third of the United States economy. Undoubtedly, significant changes are on the horizon, affecting everyone from the consumer to the provider to the payer. It’s not surprising there is much angst regarding the unknown.
While theories abound, many experts think immediate radical changes are unlikely even if Congress tries to demonstrate that it is moving quickly to keep campaign promises. The realities of the legislative process reflect many conflicting interests, ideas and agendas. There are strong incentives to keep insurance markets stable.
With Affordable Care Act (ACA) open enrollment underway until Jan. 31, plans, contracts and subsidies are in place for 2017. While there will certainly be changes beyond 2017, their direction should become more clear over the course of the next 12 months, since healthcare is at the top of the agenda. Among people who want to repeal the ACA, many think an immediate repeal with a several-year transition period to keep markets stable could work.
What does the ACA include?
President Obama’s massive 2010 healthcare law took a significant amount of time to develop and implement and is broader than most people realize.
“The Affordable Care Act contains hundreds of provisions affecting Medicare, program integrity, the healthcare workforce, biosimilars, prevention and other issues unrelated to what most Americans think of as “Obamacare,” said law professor Timothy Jost in a blog post. “The ACA is inextricably interwoven into our healthcare system and is not going away immediately.”
Pulling the rug out from under the millions who have come to depend on the insurance and creating instability in the insurance marketplace are scenarios politicians want to avoid.
A wealth of opinions
There’s no consensus, but here is what some observers think is likely:
- Portions of the ACA will remain. In November 2016, president-elect Donald Trump said he supports keeping the provision allowing young adults to remain on a parent’s plan until age 26, as well as the ban on denials based on pre-existing conditions. These two parts of the law have strong bipartisan support and are popular with the public.
- Portions will be eliminated or replaced. Subsidies and tax penalties are unpopular with ACA opponents. However, these are considered key components in making coverage affordable since they subsidize that coverage.
- Some long-held Republican alternatives may be implemented. Tax credits, increased reliance on health savings accounts and taxing certain employer-provided healthcare plans are part of several replacement proposals.
Hurdles to jump
While Congress can act immediately to move ACA financial levers through budget reconciliation, the new administration doesn’t take over until Jan. 20. Cabinet nominees need to undergo Senate confirmation. A budget from the president is due to Congress Feb. 6 and must be agreed to. Any further legislative action needs to achieve passage in both houses of Congress and be signed by the president.
ABILITY provides help navigating the administrative and clinical complexities of an ever-changing healthcare system. Check out our resources here.