Monitoring President Trump’s Actions on the ACA

As President Trump sets up his administration, one of his top agenda items is repealing the Affordable Care Act (ACA). Although there is not a concrete plan in place on how to repeal/replace it, certain recent actions are giving us a glimpse into what the future of ACA and health care may look like.

ACA Executive Order

President Trump signed an executive order on January 20, 2017, which addresses the Affordable Care Act.  The order emphasizes that the administration’s goal is to repeal the ACA.

Specifically, the order directs federal agencies (who are responsible for administering ACA) to:

• Waive, delay or grant exemptions from ACA requirements that may impose a financial burden on individuals, families, patients, health care providers, etc.
• Provide greater flexibility to states in implementing health care programs
• Encourage the development of free and open health care market (for health care services and health insurance) in order to provide maximum option choices for patients and consumers

Note that an executive order is a broad policy directive that establishes how laws will be enforced by the administration. It does not change any existing regulation nor does it provide any specific guidance in regards to a particular provision/ requirement. The impact of this order will remain unclear until the new administration is in place and policies, regulations and guidance are created to carry out these directives. In addition, some states prohibit any significant changes to be made midyear because health insurance policies are already in place for 2017.

Budget Resolution Passed

Earlier this year, both the U.S. House of Representatives and the Senate passed a budget resolution which includes “reconciliation instructions” that enable Congress to repeal ACA with a simple Senate majority vote. Reconciliation makes for passing legislation much easier and provides filibuster protection. A filibuster is used when a senator attempts to delay or block a vote on a bill by speaking as long as they wish.

The reconciliation process does however; only allow you to pass bills that affect spending and revenue.

So when a budget reconciliation bill is proposed, it can only relate to budgetary matters of the ACA. Some key ACA provisions that could be affected include:

• The individual mandate
• Employer shared responsibility rules
• Federal exchange subsidies

Right now, the budget reconciliation bill is being drafted by Congress. Once it is voted upon and passed, it will move onto the president for approval.

NAHU Capitol Conference

In early February, health insurance agents and legislators gathered together at the National Association of Health Underwriters’ (NAHU) annual Capitol Conference in Washington D.C. Legislators shared their vision and gave a glimpse into what the GOP health care fix will look like.

Republicans’ general goal in health care reform is “pretty simple,” said Sen. Lamar Alexander (R-Tenn.) chairman of the Senate’s Committee on Health, Education, Labor & Pensions.  “A fundamental problem with the [Affordable Care Act] was expanding a system that already cost too much and made it more expensive. We should try to give the American people more choices of lower cost insurance and move decisions out of Washington and into the hands of the states.”¹

Legislators agree that a full repeal (of ACA) without an acceptable replacement would be detrimental to everyone.  They are thinking that the dismantling of ACA will be a ‘piecemeal repeal’ where changes will be made in stages and full change/implementation could take up to six years.

What Should School, City and County Employers Do?

At this time, school, city and county employers should continue to comply with all ACA regulations and requirements. National Insurance Services will continue to monitor the situation and keep you informed about any regulations/requirements that may change the way you do business.

Contact your NIS Representative if you have any questions.

¹Kalish, Brian M. “GOP tells NAHU healthcare fix will take years.” Employee Benefit Advisor, 16 February 2017, www.employeebenefitadviser.com/news/gop-gives-nahu-a-long-timeframe-on-healthcare-reform-changes. Accessed 17 February 2017.