Benefits Buzz

The Future of the ACA (or Lack Thereof)

Posted on November 15th, 2016

Several Republican political leaders indicated their efforts to repeal the Affordable Care Act (ACA) would end if Hillary Clinton were elected as President, but the exact opposite happened. Donald Trump has been elected to serve as the 45th President of the United States and is set to take office on January 20, 2017. Trump has said on numerous occasions that the very first thing he’ll do is repeal “Obamacare.” Could this actually happen?
Well, not only will we have a Republican President, but Republicans will also have the majority of seats in the Senate and House of Representatives. In addition, Trump is expected to appoint a new Supreme Court Justice shortly after taking office which would make 5 of the 9 Justices having more Republican, Conservative political views.
The cards seem to be falling in place for a repeal of the ACA, but let’s stop and do a quick reality check. A full repeal of the ACA is highly unlikely, if not impossible to occur. Republicans just barely have the majority in the Senate. They have control of 51 out of 100 seats which at best will increase to 52 depending on the results of a runoff in Louisiana. In order to fully repeal the ACA, they would need a super majority in the Senate, or 60 votes in support of repeal. In addition, at least eight of the elected Republican Senators have indicated they didn’t vote for Trump, so we don’t really know which way they’ll sway on some of the issues. For now, a complete repeal of the ACA is unlikely.
That being said, a lot could and probably will change with the ACA. There is a process referred to as reconciliation where bills can be passed with only a simple majority in the Senate, or 51 votes (which Republicans have). The only types of reconciliation bills that can be passed are those related to the federal budget or federal government spending, and guess what? 
There’s a lot of things in the ACA that are budget-related that could get repealed through the reconciliation process, including, but not limited to the Individual Mandate, Employer Mandate, Cadillac Tax, Exchange subsidies, Medicaid expansion, Health Insurer Tax, taxes on pharmaceutical companies and medical devices, and more. 
Some things couldn’t be repealed through the reconciliation process because they aren’t budget-related, such as the prohibition of denying coverage to someone based on medical history, covering dependent children up to age 26 or providing coverage for in-network preventive care at 100%. However, these things seem like small potatoes compared to the budget-related items that could get repealed. Whether formally repealed or not, it seems like the ACA would really start to crumble if a lot of the budget-related items go away. 
If we start to see some of these big ticket items getting repealed, then the Republicans are going to have to come up with a replacement plan or else an estimated 20 million people could end up uninsured. For example, if you eliminate Exchange subsidies and scale back on Medicaid expansion, what are these people supposed to do for insurance? 
Republicans will also need to be strategic in the things they try to repeal. For instance, if you repeal the Individual Mandate on day one, you’re probably going to see a lot more insurance companies getting out of the individual market since presumably only sick and needy people would buy coverage. 
There’s a lot going on and only time will tell how this all plays out, but the ACA is definitely now on the chopping block. It no longer seems to be a matter of it will change but a matter of how it will change. 

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