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ACA Watch 2017: Trump Signs Executive Order, Congress Forges Ahead

As I indicated in my first article of the year, change is imminent. The real questions are “what” will change and “when” will it happen.

As the new 45th President of the United States, Donald Trump is not wasting any time jumping in to make good on his campaign promise to repeal and replace the Affordable Care Act (ACA). Signing an executive order on inauguration day instructing his administration to seek the “prompt repeal” of the health care law marks the beginning of a new health care journey.

While the executive order is not a law and does not repeal the ACA, it sets the tone for Congress and the regulatory agencies— the Department of Health and Human Resources (HHS), the Internal Revenue Service (IRS), and the Department of Labor (DOL) — instructing them to make every effort possible to delay, change, or eliminate any provisions of the ACA that imposes a “cost, fee, penalty or regulatory burden.”

Stepping in line, the 115th Congress is responding to the call for change. Both the House and Senate are introducing pieces of legislation that range from modifications, or elimination of certain provisions, all the way to full repeal of the law.

Listed below is the summary of the active health care bills that correlate to repeal or modification of the ACA:

Bill Text/Topic House Senate
Full repeal • 7 bills

• 303 co-sponsors

• 3 bills

• 6 co-sponsors

Partial repeal • 16 bills

• 282 co-sponsors

 • 2 bills

• 29 co-sponsors

HSA expansion • 4 bills

• 27 co-sponsors

 • 2 bills

• 2 co-sponsors

Real action on the ACA repeal is pending the appointment confirmation of the new HHS Secretary, Senator Tom Price. All stakeholders expect that confirmation to come soon, even as early as this week. Senator Price is known for his forward thinking on health care reform and consistently put forth reform bills in the last three Congresses. President Trump and Speaker of the House, Paul Ryan, confirm their support for Senator Price and look to him to lead this charge.

Moving forward, we will continue to see a lot of activity in Washington; however, any change requires a careful look at the effect on individuals and the market.  The key is stability and sustainability.

The good news is that as the administration pushes forward they are aware that it will take time. In a recent interview, President Trump stated, "We're going to be putting it in fairly soon, I think that yes I would like to say by the end of the year at least the rudiments, but we should have something within the year and the following year."

As I prepare for my trip to Washington this week and meetings with our Congressional leaders, your questions and concerns are on the top of my list.  Please make sure to join me for my next webinar on February 21, “Greetings from the Hill,” where I’ll share with you the results of my visit, insights into the thoughts of our Congressional leaders, and what new developments are on the horizon.

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12 comments

  1. most of my employees do not like the fact that the government is forcing them to have health insurance or pay a penalty. While most would agree that having the coverage is a benefit, there are those who do not want the extra financial burden and are willing to take the risk of not having coverage.

    I do agree that there are some good provisions of the current ACA - coverage for children up to age 26 and coverage for those with preexisting conditions. However, most of the ACA has placed undo stress and work on businesses to track and report employees. Just some food for thought.

    1. You are not alone. There are many that feel that the ACA made some good steps forward for individuals, especially in the areas that you indicate, but that it's come at a significant price. Another byproduct are the additional administrative burdens for employers. There is bi-partisan support for keeping the dependent age at 26 and the elimination of pre-existing conditions as can be witnessed in recent Congressional hearings and in the new "replace" bills introduced just recently. It's safe to say that there is a lot of ground to cover to draft a new law that will improve and not disrupt. Time will tell.

  2. HealthCare Headhunter
    February 9, 2017 at 1:05 pm

    I can't find a date this was written but belive I heard just yeterday Trump was taking his foot off the gas and thinking late '17 or now into 18 before taking action as impression was he wants viable options for replacement first.? ? Is Trump changing his mind overnight or is this somewhat dated? (2/9/2017)

    1. In a recent interviews, both President Trump and Speaker of the House, Paul Ryan, confirm their desire to produce a solution that is signed into law this year. That doesn't necessarily mean that all provisions will be implemented this year. If you remember, the sweeping ACA legislation was signed into law in 2010 with some provisions going into place in 2010 and 2011 but the bulk of which went into effect in 2014. It is fair to say that we will see the same thing happen here, and rightly so. Like the ACA, there will undoubtedly be some provisions with immediate action and others with future effective dates.

      The legislative process takes time. Certain provisions that effect the federal budget may pass sooner if the Senate exercises the budget reconciliation process. All other provisional changes, repeal, or replacement would need to go through regular order, which takes time.

  3. We are a small business that is happy to provide full health care benefits to our employees. Every one of our owners and employees strongly opposes repeal of the ACA. Neither the Administration or Congress have identified any substitute that would provide affordable health care for all. America is so behind the curve in this area -- the richest country in the world refuses to take care of its own. Shame on us.

    1. First, I want to thank you and all the employers who work tirelessly to provide health insurance to your employees. This is an invaluable benefit to the health and well-being of your employees. Many individuals either don't work for an employer offering health insurance, are self-employed, or are contract workers and would love to have this type of support.

      I think all would agree with you that affordability is a significant problem in today's market. It's vital that any new substitution or solution address this fundamental issue. Any sustainable solution must contain sound financial and economic principles to be successful. Many factors contribute to the high cost of health care and all must be taken into consideration drafting a solution. Unfortunately, this didn't happen overnight; it's been decades in the making. So, it's not a "quick fix" at this point.

      I encourage all to share their stories and concerns with their Congressmen. Each voice is important to help educate and identify all aspects of the current landscape, it's impact, and the drive solutions that will meet the needs of the people.

  4. The ACA has some redeeming qualities such as the Pre-existing clauses but there are other mandates that resulted in immediately higher premiums, namely the minimum essential benefits: maternity coverage, chemical dependency and mental illness coverage that are required to be in every single policy. Former policies would treat these as 'a la carte' items.
    I don't know too many 50 year old men who need maternity coverage!
    Minnesota had one of the best platforms for health insurance. We had major insurers who offered excellent networks and benefits. We also had the MCHA (Minnesota Comprehensive Health Association) that provided much needed coverage for the high risk pool, those who were denied coverage by the major insurers for pre-existing conditions but could still have affordable coverage. For those who could not afford either option, there was MinnesotaCare and Medicaid. These last two are still available today.
    The ACA did not address the main problem: why is health care so expensive?
    When the high deductible plans emerged in mid-2000, this provided a means to save on premiums and put money away (pre-tax) for the major medical expenses. For the first time, people actually asked what something would cost? Consumer driven health care would result in more competitive pricing among the health care providers.
    My husband needed to consult with a cardiologist after his heart surgery. When he made the appointment, he asked what the fee would be...the receptionist had to look it up and call him back. No one had every asked her that. He explained that we had a high deductible plan and that he would be paying for it himself.
    We wouldn't think to drop our car off at the mechanic and give him carte blanche to fix it. We would ask for an estimate and maybe even get a second quote to keep everyone honest.
    Why don't we hold our health care providers to the same standards?
    I own a small/large business (this definition changes each year!) and was required to provide group coverage for my employees. Prior to that, we gave each employee money to buy their own insurance. They could choose their deductible, their carrier and their coverage. My employees were informed consumers and chose their medical insurance based on their needs.
    Prior to the full implementation of the ACA, my employees were able to choose individual/private plans that were up to 50% cheaper than any group coverage I could provide to them.
    The ACA needs to be overhauled to make it affordable for all but we also need to work on getting the overall cost of health care down to a manageable level.

    1. The cost of medical goods and services definitely drive the cost for health insurance coverage. As with other industries, but maybe more so than some, safety and regulation also add to the cost. It stands to reason that a better understanding of the costs of care and treatment will be instrumental in any sustainable solution.

      Using your car analogy, the demand for mandatory airbags adds to the cost of purchasing a car. Even though this is in the best interest of individuals, they are still required to pay for them. A consumer could, however, choose a smaller, more economical model with less features to help offset the cost of the airbag and still purchase a car that's in budget that will safely get them from one place to another.

      The health care industry also mandates certain treatment and coverage through both state and federal laws and regulations. From a care standpoint, one could, in some cases, use clinics or some lower cost facilities or physicians but consumers have less comfort, knowledge, and desire in doing so when it comes to their personal and family health. Unfortunately, health care and treatment is not a one size fits all. As such, itis adds a significant level of complexity when trying to understand how to better manage the cost.

  5. People need health coverage - it should not have to be negotiated - it should be a right. But given our American system, I still don't understand what was wrong with Medicare available for everyone as a low cost basic option in the health insurance market. Employers could offer it as a lower cost option along with plans that offer more coverage. Individuals could buy it directly and coverage would move with them as jobs and/or locations changed. It wouldn't put the Blues or any other large health organizations out of business, since basic Medicare doesn't cover everything - witness the huge market in supplemental plans.

    This scenario would be an acceptable alternative to the ACA and may also help keep Medicare solvent going forward.

    1. Medicare actually covers a significant portion of the largest hospital expenses. When Medicare came about in the 1960's, it was designed to help those over 65 obtain coverage that was unavailable, at that time, in the marketplace and to protect them against large expenses. Comparison of costs and coverage under Medicare to that of plans in the marketplace are probably fairly comparable.

      Medicare Part A covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care. There are some out-of-pocket costs associated, as in other health plans. Typically, Medicare Part A is "free" if the individual paid Medicare taxes while working. Otherwise, it costs $413/month for 2017. The Affordable Care Act increased the Medicare tax to those making more than $250,000 annually. So, they pay a higher rate for the same coverage as others. Medicare Part B covers physician expenses, outpatient therapy, and durable medical equipment. The cost is between $134 and $428 per month depending on the income level. All individuals signing up for this coverage pay premium. Medicare Part C is an alternative managed care plan whose cost vary by plan. Medicare Part D covers prescription drugs and varies by plan. There is a great chart that explains the costs, eligibility, and plan options at https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html.

      There is currently a bill in Congress title "Medicare for All" that begins to lay out what that option may look like. It's hard to say how what the impact to costs would be for a program like this but we may very well find out if this bill moves forward since the Congressional Budget Office would have to score the bill to determine the cost associated.

  6. We provide expensive health care for our employees. It needs to be affordable for a small business like ours. Having a bit of competition and being able to sell across state lines makes sense! Competition usually makes competitive pricing. Also as it stands right now there are too many mandatory coverages (one being free colonoscopy over 50) which is driving up prices.

    1. Annette Bechtold
      March 6, 2017 at 9:47 am

      You are correct that a significant driver of health insurance costs is mandated coverage. While the federal government mandates certain coverage through the Affordable Care Act, each state also has its own set of mandates. This is where the challenge of selling across state lines comes in. If health insurance carriers are required to offer coverage that includes the mandates of the states it wants to do business in, it may not create the competitive landscape we're looking for. For example, this has been allowed in the state of Georgia for many years but not one out-of-state carrier has participated because they would have to include all of GA state mandates. If modifications are allowed in this area, we could see some positive impact.

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