The 2016 Presidential election has come to a close, and Donald Trump will be the 45th President of the United States. The election came with a series of disparities between Donald Trump and Hillary Clinton on a number of issues, mainly involving the Affordable Care Act. On the campaign stump, particularly in the last two weeks right after headlines came out about large premium increases, Trump announced he would repeal the ACA.
While Trump advised there were “good parts” to the ACA (aka as Obamacare), the concept of actually keeping it was seemingly not in the cards. However, just a few days following Trump’s electoral win, he has suggested he may not be repealing the Affordable Care Act, and only amending it.
There are several points to consider beyond a simple change of heart. On the day after the election (November 9th)—which was open enrollment for healthcare—over 100,000 individuals headed to the Health Insurance Marketplace to purchase health insurance. Per Obama’s administration, this is the biggest sign-up in 2016.
Further, after meeting with President Obama in the days following the election, Trump was guided on a few points from Obama to which he said he will review “out of respect.” While he hasn’t made a firm announcement on whether or not the Affordable Care Act will be repealed, his considerations and restructuring of it is a clear indicator that it more than likely will not go away completely.
Two parts he indefinitely plans to keep are the provisions that pre-existing conditions cannot be factored into health insurance providers’ decisions for providing coverage, along with allowing children to remain on their parents’ plan until they turn 26 years of age. Perhaps the GOP was a little too trigger-happy when it came to their excitement over removing the law in the first place.
The two aforementioned provisions would have to remain either way, unless the GOP can figure out a way around the likely Democratic filibuster given the absence of a Republican supermajority. However, a simply majority in Congress can make changes via the “reconciliation process” to change those provisions that only affect the federal government’s financial role in the law, including subsidies, platforms like Medicaid expansion, and budgets for promoting the marketplace to individuals in an effort for more sign-ups.
In the provision for preventing companies from denying coverage due to pre-existing conditions, this is a downstream effect of keeping many of the law’s mandates. Consider that if the provision that precludes insurers from denying coverage to those with pre-existing conditions continues but without the accompanying individual mandate and premium tax credits and other subsidies to incentivize enrollment and the accompanying employer mandate to incentivize widespread coverage, only the sickest will get insured, thereby causing a death spiral in premium costs.
While states like Colorado have attempted universal healthcare reform with ColoradoCare, which failed to pass, Mitt Romney’s RomneyCare for Massachusetts has allowed for statewide coverage through the threat of being penalized with fees that far exceed the ACA’s existing penalties. Enforcing yet another restructuring of each state’s respective plans can require years of organization that could exceed even Trump’s term. Consider the fact that the ACA came into existence in 2010 and has still not found secure footing even six years later. Shaking things up drastically could produce a 4-year headache for our 45th President.
It’s a cause and effect that neither Trump nor his presumed advisors (including speaker of the House Paul Ryan) have even fathomed. Reality has now set in.
Still, those who are pro-ACA are not out of the woods just yet and neither is the fate of their health plans. Until Trump takes a firm stance on his health care plan, complete with a blueprint beyond HSAs and governmental lumps sums, the pendulum can swing in either other direction as it already has.
Photography credit: Transition 2017