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President-elect Trump and the future of the Affordable Care Act

November 19, 2016

By Scott Lyon, Senior Vice President

As I write this article, it has been a week since the 2016 election and I have been asked on a number of occasions – what do you think will happen with the Affordable Care Act or what do small business owners want?  Do they want to simply repeal the ACA or do they want to repeal and Replace, or Replace and Repeal?  Three very different choices.  Those are interesting questions, especially if you knew my recent track record of making any kind of predictions.  We all know the campaign rhetoric of candidate Trump – repeal the ACA as job one.  But, now that he has won the election, his position seems to be softening a little and he has indicated a willingness to maintain a couple of the ACA’s provisions, namely the opportunity to purchase health insurance without medical underwriting and the ability for a child to stay on his/her parent’s health insurance plan until they reach 26.

We all know that allowing a child to stay on his/her parent’s plan is the easier of the two, and with a son approaching his 25th birthday and attending graduate school, I appreciate this provision of the ACA.  The ability to have a guarantee issue health plan, without some sort of a strong incentive to get everyone in the pool –  well, that one is a whole lot trickier and I think that President Elect Trump is beginning to figure that out.  I have joked that if we move to a system of guarantee issue without any ability for a health insurer to decline an application, I am going into business with a friend that owns a local ambulance company and I will sell policies on the way to the hospital in the back of his rigs…

All that said, here are a couple thoughts.  As with any law, including the ACA, until it is not the law, it is the law.  Just because you think, or hope, that the ACA is going away, does not mean that you (or your customer) can stop complying with the law.  If you have 50 or more full-time equivalent employees, you are still an Applicable Large Employer and you still need to offer coverage and to file your 1094 and 1095 for 2016, the metal tiers are still in place, etc.  

My best guess, and my hope, is that President Elect Trump and the leaders of the House and Senate will step back and start with a clean slate.  As a nation, we need to give thought to some fundamental questions, things like:

  • What do we really want our health insurance system to be?  Something that pays for everything or something that provides catastrophic coverage?
  • Is health care a right or a privilege? 
  • How do we first define and then balance access, quality and cost?
  • How should the pieces – private health insurance, Medicare, Medicaid and the VA all come together?   Should they come together?
  • Where does personal responsibility enter into the equation?

Once we answer these questions, and many others, then we can begin either dismantling the ACA or building a better system.

A reporter asked me – What do small business owners want?  Well, first she asked me if I would give her the name of a SBAM member who would speak to their dislike of the ACA.  When I got done laughing and told her no, I gave her my top ten things small business owners would like to see from any reform:

1. They want the same thing they have always wanted – to pay less for health insurance which means we have to find a way to lower the cost of delivering health care across the provider spectrum.

2. They want price stability and price predictability

3. Reduced regulations – both ACA and more – ERISA, Control groups, etc.

4. Price and Quality transparency – who does what the best and for how much money

5. 5:1 Rate bands

6. Move back to the pre-ACA single, two-party and family rate structure

7. Move the definition of a full-time employee back to 40 hours a week

8. Reform or eliminate the Cadillac Tax

9. Full deductibility of health care premiums

10. Waiting period reform (ACA limits to 90 days)

What did I miss?  Let me know, because through our affiliation with the National Small Business Association and our relationship with the Michigan delegation in Washington, D.C., we will get asked and we will have a great chance to make our voices heard.  

Thanks, and hold on; it is going to be an interesting ride for the next several months.

Scott Lyon, Senior Vice President
(800) 362-5461 ext. 232
scott.lyon@sbam.org 

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