President Trump & The ACA: we’re in for another wild ride

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​President Trump has vowed to repeal and replace Obamacare.  But will the ACA really go away?

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What a month!  I think it’s safe to say that few people saw this coming – perhaps not even the President-elect himself, but now, “What will really happen to ACA?” is the question at hand.

Donald Trump campaigned hard on repealing Obamacare and replacing it with “something great,” but the reality is far more challenging than the rhetoric.  It would be chaotic, not to mention politically unpopular, to have 22 million enrollees lose ObamaCare coverage.

Even Trump himself acknowledges some of the positive features of the Act and is already back pedaling.  In his 60 Minutes interview, he hedged that there are some things he would keep, like pre-existing condition coverage and allowing kids to stay on their parent’s plan until age 26.  And he wants to “repeal and replace” without a gap between ObamaCare and its replacement.

So, whatever happens to ObamaCare, a full repeal won’t happen overnight.  The wheels of government tend to roll pretty slowly, plus a full repeal and replace would mean passing a bill in the House and Senate with a supermajority.  If the Democrats stick together, the Republicans won’t be able to meet that requirement. 

However, there are a few ways that the President and Congress can make changes sooner than later:  Executive order, regulatory or administrative process, and reconciliation.  Pundits declare that Trump could undo Obama’s Executive Orders quickly; however, Obama did not really use Executive Orders for changing provisions of the ACA.  Trump could use regulatory or administrative process to effect change, such as directing the IRS not to collect the employer tax. Maybe his first day he could wipe out the employer reporting requirement? Okay, wishful thinking. 
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Congress can skirt around the super majority requirement by using reconciliation, which only requires a simple majority.  Anything can be added to a Budget Reconciliation Bill, as long as there is a financial impact to the Federal Government; therefore, we could see changes to fees, taxes, and advanced credits. The Republicans already tried to use reconciliation last year, so they already have a “plan of attack,” which includes rollbacks of taxes and fees with a 2 year transition timeline.  Since they convene in the first week of January, they could likely have a Budget Reconciliation Bill on the President’s desk the day he is inaugurated.  

What lies ahead?

If I gaze into my crystal ball, here are the hot topics that look like they will be dealt with first and foremost – the acclaimed first 100 days:

1. Pass a Budget Reconciliation Bill that would include changes to Obamacare funding
2. Deal with drug price gouging, potentially adding the ability to purchase Canadian drugs
3. Pressure the EEOC to modify ADA and GINA in order to continue the ACA wellness rules
4. Start the process to repeal and replace ObamaCare (may see changes come out in waves)
5. Get a nominee through to the Supreme Court
6. See if ¾ of the states would ratify a Constitutional amendment for term limits
7. Comprehensive tax reform

I threw in non-ACA related topics, since it won’t all be about ObamaCare….
 
As far as what “TrumpCare” could look like?

• Continue pre-existing condition waivers
• Continue to cover children to age 26 on a parent’s plan
• Repeal the Cadillac tax (neither side likes it)
• Repeal the federal mandate to buy health insurance
• Expand Health Savings Accounts to allow more people access
• Expand carrier sales reach to offer insurance across state lines
• Provide Medicaid dollars to the states and allow them to use as they see fit

​Regardless of what the future holds, for now we need to move ahead and comply with all the current ACA rules in place for 2017.  Strap in tightly.  It promises to be another wild roller coaster ride.