Choice Stories

January 16, 2017

What’s Likely to Stay – and Go – as Part of Proposed ACA Repeal

What’s Likely to Stay – and Go – as Part of Proposed ACA Repeal

While we don’t know with certainty the timetable for any repeal (or repeal and replacement) of the Affordable Care Act (ACA), there are some parts of the current law expected to remain in place, and others that could likely go away under President Trump and a Republican-led Congress.

Let’s take a look at a few of these.

What’s likely to stay?

Guaranteed coverage: a big part of the ACA – some would argue the most important part. The ACA allows individuals to get health coverage even if they’re sick. The downside is members know sicker people have a greater need for care, and members have to spread the risks among all the people members. That makes premiums higher for those who may not use the doctor or a hospital very often. Under one proposed replacement plan, while those with a pre-existing condition will still be able to get coverage, they may pay more. Currently the ACA limits the premiums that can be charged to the oldest enrollees to three times the amount charged to the youngest members. Republicans would change that, so members could charge the oldest member five times as much as the youngest member. Allowing parents to cover their children up to age 26 is one of the most popular provisions of Obamacare. President-elect Trump and congressional leaders say they want to maintain this provision, although it was not part of the Senate discussion on January 11.

What’s likely to go away?

The mandate that most Americans have health insurance or pay a tax penalty is likely to be eliminated. Republicans have been consistent critics of the so-called individual mandate since the ACA became law. It’s uncertain what alternative might be implemented to keep premiums in check by attracting a mix of healthy and sick participants, and to discourage people from going on and off of insurance as their needs and health change. One proposal would allow members to charge sick people more if they don’t maintain “consistent coverage. Taxes are a big part of the ACA. Two examples are the 3.8 percent investment income tax for those over a certain threshold and added payroll taxes on high-income earners. Both are targets for the GOP-led Congress. Meanwhile, those earning less could actually see their taxes go up, according to the non-partisan Tax Policy Center. Insurance marketplaces – also known as exchanges – could be on the chopping block, too. Republicans want to eliminate these online marketplaces and the income-driven subsidies that go with them.

Consumer advocacy groups warn that without the exchanges and the subsidies, millions who have coverage currently through the exchanges could be left without vital health insurance. It’s not known yet whether any state running its own public health insurance exchanges might consider maintaining its program. In California, the new state budget proposed by Governor Brown makes no allowance for it – or maintaining the expansion of Medicare – without ongoing federal assistance. Keeping up: If you’d like to learn more about possible changes to the ACA as Congress debates the matter, your CaliforniaChoice employee benefits broker can help. If you don’t have a current broker, we’ll help you find a broker to speak with about your employees’ health insurance and related needs.

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