Trump and the ACA

Hold on to your hats people. All the stuff you learned to do to implement the ACA will be methodically undone. And that’s if we are to believe Trump’s campaign rhetoric. For some of you, okay most of you HR folk, this will be a blessing because we all know that implementing this hot mess of a thing was stressful.

To recap, all of this started in 2010 with the passage of Obamacare as our GOP friends have so endearingly referred to the Affordable Care Act (ACA).

The very utopian goal of the ACA was to provide access to affordable and quality health care coverage to all Americans regardless of age, income or previous health conditions, reduce the number of uninsured Americans and reduce healthcare costs overall. And then congress got ahold of it and made the ACA’s actual mechanics more complex  and nebulous than the instructions of a shitty piece of Ikea furniture.

The ACA eliminated lifetime maximums, eliminated denials of health care coverage due to pre-existing conditions, put limits on annual out-of-pocket maximums, raised the age to 26 for covered dependents and mandated free, no-cost preventive health exams amongst other things. The Individual Mandate of the ACA requires individuals and their families, with some limited exceptions, to have minimal health coverage or incur a penalty. To further this agenda, the ACA’s Employer Mandate required companies of a certain size to offer comprehensive, affordable group health insurance to covered employees.

It’s no secret that the GOP hates Obamacare and decries it as a symptom of a socialist government. Republicans have alleged that the program would actually increase health costs and result in death panels, whereby government bureaucrats would actually decide the life or death fate of those considered uninsurable.  The GOP painted a picture of the ACA as the final nail in the coffin of small businesses in the U.S., another example of over-regulation of business and yet another obstacle to free enterprise.

And even when the GOP was too busy dragging their feet in protest to just about everything the Obama Administration attempted to do in the last 8 years, they pledged to find a sliver of time to offer an alternative plan to the ACA. But hence, it was not meant to be, as we sit here today, they have not presented their alternative. And that is why Trump is in a world of shit now trying to figure out how to dismantle this thing while somehow safeguarding the millions of Americans who are now insured on the health care exchanges made possible by the ACA.

 

Here is what I think.

Don’t hold your breath. This thing is gonna take a lot of time to figure out. What was built in the past 6 years can’t be undone in one year. Trump states he will repeal and replace Obamacare. With upwards of 20 million Americans in jeopardy of losing coverage with the repeal of the ACA, I think Trump would have to think twice about pulling the rug out from under that many people.

I think the individual mandate is dead. No longer will all Americans be required to have health insurance and no longer will individuals who opt-out have to pay penalties. I think this is likely to be one of the areas of the ACA that is repealed quickly. Thus no more 1095 administration.

I think the employer mandate is dead. However, many medium to larger size companies had comprehensive and affordable coverage long before the ACA as a means to attract employees. For those companies, this won’t cause much ripple. For smallish companies that did implement a health care plan- they will have to decide to keep it to remain competitive in job market that is employee-driven.

Trump and the GOP are going to introduce some sort of Health Savings Account whereby companies are either required or strongly encouraged to make contributions. Ultimately this looks like a stipend that employers give to their employees to buy health insurance. They are also going to allow coverage to be sold across state lines which theoretically increases options and decreases premium costs.

Based on Trump’s 100 day plan, what’s clear is how fast he will act to repeal Obamacare. What’s not clear is what he will replace it with. And if I’m reading between the lines, I don’t get the warm and fuzzies that affordable, comprehensive health care coverage for all Americans is even a priority for Trump.  And this is scary because I am confident that healthcare costs will continue to rise, that the sick will get sicker and proper coverage will be out of their reach. But for someone born with a silver spoon in his mouth, who probably has the privilege of a personal physician available to meet him in his gilded tour at the onset of tummy ache, health care coverage for all just wouldn’t even register as a thing.

 

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