In Focus: The Trump Administration and the ACA

Stephen Miller, CEBS By Stephen Miller, CEBS November 9, 2016
In Focus: The Trump Administration and the ACA

ACA Likely to Change Substantially but Full Repeal Unlikely

The employer mandate to provide coverage—and all the tracking and reporting requirements that accompany it—could go away, even without a full repeal of the Affordable Care Act (ACA). The Cadillac tax on high-value plans is also on the block. A look at the prospects for major reform of health care reform.
(SHRM Online)

Outright Repeal of the Affordable Care Act Would Be Difficult

President-elect Donald Trump vowed during his campaign to dismantle the Affordable Care Act (ACA). That will be a challenge for a Trump presidency because advocates of "repeal and replace" would need 60 votes in the Senate to overcome a Democratic filibuster in the Senate—and last night's election didn't put that many Republican senators in place. But even if Trump can't repeal the ACA in its entirety, there is much he could do through rule-making and smaller legislative changes to weaken the law and mold it more to his liking.

Some Provisions Could Be Rolled Back Using 'Reconciliation'

While most Senate bills need 60 votes to overcome a filibuster, Senate rules allow bills to pass with a simple majority if they only relate to spending, a process known as reconciliation. Last winter, Republicans drafted a bill that would fit the parameters of the reconciliation process. It would repeal the ACA's tax credits for low- and middle-income Americans to purchase insurance and would end the ACA's Medicaid expansion, essentially creating a two-year transition period in which Republicans would consider ACA replacement plans.

[SHRM members-only toolkit: Complying with and Leveraging the Affordable Care Act] 

Trump's Ideas for Health Care Reform

Trump has promised that on the first day of his administration he would ask Congress to immediately deliver a full repeal of the ACA, including the individual mandate. Trump has called for modification of existing law that inhibits the sale of health insurance across state lines, full deduction of health insurance premium payments from individuals' tax returns and price transparency from all health care providers.
(SHRM Online) 

Cadillac Tax Will Be Targeted

The ACA's unpopular Cadillac tax—a 40 percent excise tax on high-value employer plans—will be one of the first targets of the Trump administration. Trump may also draw on a plan proposed by Republicans in the U.S. House that includes a refundable tax credit to help Americans buy individual plans, and he wants to eliminate the law's individual mandate that requires Americans to buy health insurance or face a penalty.
(Employee Benefits Advisor)

ACA Provisions that Are Likely to Remain

Trump has said he favors keeping many of the provisions in the ACA, including no pre-existing condition exclusions, allowing children on parents' plans through age 26, no lifetime limitations on coverage, no rescissions, guaranteed renewability and continuing coverage protections.

What an ACA Replacement Bill Might Look like

Trump and House Speaker Paul Ryan have given only broad outlines of what an ACA replacement bill would look like. They're relatively similar plans: Individuals would get tax credits to help them buy insurance, tax-favored health savings accounts would be encouraged, insurers would be allowed to sell policies across state lines. Neither has filled in details, however.

Related SHRM Resource Page:

2016 U.S. Presidential Elections and  HR Issues

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