In the uncertain atmosphere surrounding the process of ‘repealing’ and replacing the Affordable Care Act (ACA), there are some clues as to what we can expect to come next, at least with regard with the health insurance industry. Obviously, one place to look is to President-Elect Trump himself. During his campaign, then-candidate Trump published a seven-point position statement on healthcare reform. This statement called for the repeal of the ACA in total, including an explicit reference to the repeal of the individual mandate. Trump’s position statement called for the sale of health insurance across state lines, tax deductions for individuals who purchase health insurance (similar to tax deductions for employers that purchase coverage for their employees), increases on the limits for Health Savings Account contributions (“HSAs”), and allowing HSA contributions to accumulate from year to year. The position statement also called for price transparency from all healthcare providers to allow consumers to make more informed decisions, and it called for block-grants to states for Medicaid payments. Finally, the position statement recommended access to imported, safe, and dependable drugs from oversees.
Other clues as to what will be included in an ACA replacement come from an analysis of individuals that President-Elect Trump has selected to work for him. For example, the President-Elect has selected Rep. Tom Price (R-Ga.), to head the Department of Health and Human Services. Mr. Price is a 62-year-old, six-term congressman and orthopedic surgeon from the Atlanta suburbs who has chaired the House Budget Committee for the past two years. Mr. Price has stated that the replacement for the ACA will bear a “significant resemblance” to the 2015 budget reconciliation bill. Mr. Price also has stated that Republicans can keep the protections for those with existing medical conditions without requiring that all individuals have health insurance coverage. Mr. Price has advocated focusing on “the real cost drivers” of healthcare price increases, which he has said include regulatory burdens, taxes, and medical malpractice litigation. Mr. Price has also promoted tax credits (as opposed to subsidies) to help people pay for insurance; he has pushed for greater flexibility for individual HSAs, similar to the position advocated to President-Elect Trump; and he believes there should be state-run “high-risk pools” for people with pre-existing conditions who might otherwise have difficulty finding affordable coverage.
Over the next several months, there will be many press stories as well as other speculation about the timing and details of the Republican alternative to the ACA. The key is to ignore the hype and focus on the three dozen members that will be actually putting together the final bill (or bills). In the House of Representatives, the key committees are Energy and Commerce as well as Ways and Means. In the Senate the key Committees are the Health, Education, Labor and Pensions (HELP) and Finance. The members of these committees need to know all interested parties’ needs and requirements for the future. The ACA has been in place for seven years. It is entirely likely that the next bill will also be in place for years. If the needs of the insurance industry are left out of this bill, it may be frozen out for some time.