One of the most-watched and debated pieces of legislation in recent history is the Patient Protection and Affordable Care Act (PPACA), originally enacted in 2010 under President Obama. For purposes of our article we will refer to this act as the Affordable Care Act (ACA). As President Trump took the White House and Republicans took control of Congress in 2016, organizations were just beginning to get the hang of offering ACA-compliant benefits. The watershed in Washington got people wondering, “What will happen to this law?” Some changes to ACA are already having an impact on consumers and benefits providers, and we anticipate further changes as control of the House of Representatives swings to the Democrats, who aim to protect and expand the ACA.
While state governors are issuing executive orders to either strengthen or weaken ACA requirements at the state level, the main focus of insurance regulators and benefits administrators is what’s happening in Washington, D.C. One of President Trump’s early executive orders, issued in 2017, focused on:
- Strengthening healthcare reimbursement accounts (HRAs): Expand the use of HRAs to give employers more options when offering healthcare to employees.
- Increasing access to short-term health insurance plans: Increase access to short-term plans, opening up options for young, healthy individuals looking to fill coverage gaps.
- Expanding association health plans: Give small business owners access to more choices and better coverage.
An executive order makes a broad statement of the policy position of an administration. The stated goals of President Trump’s actions are to increase competition among healthcare insurance providers and give consumers more and better choices for healthcare. The exact details of how these new policies will apply and how the Executive Order will integrate with existing laws is determined by the governmental agencies that administer the laws.
The executive orders issued by the Trump Administration made some major changes that began to take effect in 2018. An additional goal of the accompanying regulations was to take steps that would cut the increasing costs of healthcare policy premiums and give states and consumers more options to tailor plans to fit their needs.
After the executive order and the removal of the individual mandate, the Department of Health and Human Services, the Treasury, and the Internal Revenue Service begin the process of issuing regulations to explain the details of how these changes would be enacted. Some regulations, such as the regulations regarding HRAs and association health plans, are now final, and further changes in regulations are expected. A new proposed rule on HRAs, for example, will allow employers to use their HRAs to pay for the individual market premiums of their employees.
Changes Proposed by Democrats
Newly elected Democrat Representatives have not been quiet about their plans for protecting and expanding the ACA, most importantly by working to block any repeal of the legislation. Democrat Presidential candidates for 2020 have also made healthcare access a central issue for their campaigns. Proposals range from increasing access to Medicare by allowing younger individuals to buy in to moving to Medicare for all, essentially a single-payer insurance system. The biggest issue currently under review in Congress is the question of how to limit out-of-control pharmaceutical costs in order to lower the overall cost of healthcare for the average American.
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