Choice Stories

November 28, 2016

Health Care Changes to Expect with a Trump Administration

Health Care Changes to Expect with a Trump Administration

There’s a lot of speculation about what’s to come from the new Trump White House and the Republican-controlled Congress in 2017. After all, leading up to the November election, candidate Donald Trump levied a lot of criticism on the Affordable Care Act (ACA) and he pledged to repeal and replace it if he was elected. Following the election, Trump told CBS in an interview that he would like to see some aspects of the ACA maintained. Those could include allowing children to stay on a parent’s health insurance plan through age 26, maintaining the prohibition on health insurance discrimination based on pre-existing health insurance conditions (or creating some high-risk insurance pool), and keeping the ban on lifetime dollar limits for coverage. If he chooses to do so, President-elect Trump could cancel “cost-sharing reductions” for those enrolled in ACA plans immediately upon his taking office. These are the payments that help lower-income enrollees afford their ACA coverage and related out-of-pocket costs. Republicans in the House of Representatives have sued to block these payments asserting they are unconstitutional because the Congress did not specifically appropriate funds for them.

Subsidy Coverage Could Be Changed

However, it’s open to debate whether the new administration would be willing to disrupt the health coverage of nearly 17 million individuals who have subsidized coverage through the ACA.  (According to a report from the U.S. Department of Health & Human Services, more than four of five (84%) of the 20 million current ACA enrollees receive some form of cost-sharing assistance.) What very likely is on the table for elimination in 2017 (or 2018) is the so-called Individual Mandate that requires a majority of Americans to get health coverage or risk being fined by the Internal Revenue Service. Also likely to change is the employer mandate (for businesses with 50 or more full-time equivalent employees) to provide health insurance to at least 95 percent of full-time employees or face a fine.

Employer Penalty & Charge Limits

The Employer Shared Responsibility provision of the ACA imposes a penalty on employers who either do not offer coverage or who do not offer coverage that meets minimum value and affordability standards. (The employee’s contribution to the cost of employee-only coverage cannot exceed 9.69 percent.) Limits on what insurance companies can charge older customers could be eliminated, too, as leaders in the majority party want to loosen the current limitations on insurers. The Council of Insurance Agents and Brokers, a health insurance trade group, is suggesting repeal of the ACA is unlikely in 2017, since the exchanges are already enrolling people and premiums are set for the current enrollment period that ends in late January. In remarks in November, a group executive said he expects the earliest ACA repeal to happen in 2018. That view has been echoed by others who foresee an extended discussion of the ACA “replacement” plan, which could take time to work out. Your CaliforniaChoice broker can help stay up to date on what’s changing – or is expected to change – under the new leadership in Washington. If you don’t have a broker, we can help you find one.

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