Trump Healthcare: What Will Happen to the Affordable Care Act?

Experts weigh in on proposed changes to ACA

It’s only been a few weeks since President Trump was sworn in as the 45th president of the United States. But in that short amount of time, there’s been a whirlwind of rhetoric about a Trump healthcare plan that could replace or repeal the Affordable Care Act.

If you manage a health plan, run a wellness company, coordinate your efforts as part of an ACO, or work with patients, there’s some uncertainty about the future of health insurance.

  • Will Trump healthcare actually replace the Affordable Care Act?
  • How will changes to the ACA impact cost, access, and quality of care?
  • And is there a timeline for repealing the ACA?

Those are just a few of the questions you might have since Trump signed the executive order, “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal,” on day one as president.

But you want answers. Right? While the president and his team of advisors work out the details for a Trump healthcare plan, industry experts are weighing in on how proposed changes may or may not impact the ACA.

Prepare for ACA changes in 2018

But there is at least once piece of concrete information. The ACA isn’t likely to change until next year. The process is “complicated”, and “we should have something by the following year [2018],” President Trump said during an interview with broadcast journalist Bill O’Reilly on Feb. 5, on The O’Reilly Factor.

Though Republicans now occupy the White House and most congressional seats, they will still need cooperation from Democrats to eliminate the ACA. Instead, it is likely that GOP leaders will move toward replacing the ACA through a series of smaller bills. The recent executive order was the start.

“It’s a sign that the Trump administration is looking to unwind the law in every way it can administratively,” says Larry Levitt of the Kaiser Family Foundation.

Trump healthcare plan will keep popular aspects of ACA

There is broad agreement that a return to pre-ACA healthcare and insurance is an unlikely outcome. President Trump, Secretary of Health and Human Services Tom Price, and House Speaker Paul Ryan have indicated that they don’t want to start over from scratch. They don’t want to see 18 million people suddenly lose their health insurance. Trump advisor Kelly Anne Conway insists that anyone currently insured will keep their coverage. A replacement plan would need to include provisions to prevent sharp coverage drops.

At a time when heart disease is the leading cause of death in the United States, and someone has a heart attack every 34 seconds, it’s no surprise the American Hospital Association is one of many organizations to weigh in on potential changes of a Trump healthcare plan.

“Any reconsideration of the ACA should be accompanied at the same time by provisions that guarantee similar coverage to those who would lose it,” says American Hospital Association President Rich Pollack.

Also, Trump has expressed support for some of the ACA’s most popular provisions. He told the Wall Street Journal his Trump healthcare plan will:

  • Let adult children stay on their parents’ health insurance plans until age 26.
  • Forbid insurance companies from denying coverage to people with preexisting conditions.

Individual mandate for health insurance is history

Trump’s executive order could spell the end of the individual mandate, the controversial provision that requires Americans to have health insurance or pay a penalty.

“Potentially the biggest effect of this order could be widespread waivers from the individual mandate,” says Levitt, “which would likely create chaos in the individual insurance market.”

The individual mandate acted as an incentive to keep younger, healthier people in the individual insurance market. If healthy people leave and sicker people stay in, costs and premiums will soar. This could lead to more insurers abandoning the marketplace, a move Aetna recently made.

But many Republicans argue that the mandate was onerous and ineffective as an incentive.

“Simply dropping enforcement of the mandate would be popular and easy, while causing little damage to existing coverage,” says Caroline Pearson, a consultant for Avalere Health.

A move toward universal coverage?

President Trump surprised many on the campaign trail by praising systems of universal health care. “Everybody’s got to be covered,” Trumps said during an interview on the CBS News program 60 Minutes. “This is an un-Republican thing for me to say…I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

Sec. Price agrees, and told the Senate Committee on Health last month that the goal of a Trump healthcare plan that replaces the ACA is for more people to have health insurance.

Observers like Avik Roy, president of the Foundation for Research on Equal Opportunity and author of the book, Transcending Obamacare, see this as an opportunity for bipartisan health care reform to guarantee insurance for all Americans.

“I think it’s been actually very helpful to the debate that Trump has been outspoken about universal coverage,” says Roy. “My hope is that the president can be a very important part in steering Republicans in the right direction.”

Slowing the move to value-based care

The health care system is transitioning away from fee-for-service payment models to value-based care. A new emphasis on quality over quantity is expected to improve health and lower costs. The ACA created Accountable Care Organizations (ACOs) and population health initiatives to drive this transition. And analysts are wondering how the move toward value-care will be affected by an ACA repeal.

“Many people have concern that the Trump administration would move away from value-based care,” says Bill Bithoney, who runs the consulting firm BDO Consulting. “Nobody really knows what the Trump administration is going to do…but I do know that without a movement toward value-based care there’s no way to control spiraling health care costs.”

In December, a 43-member coalition of the nation’s top insurers, employers, and health systems expressed concern that Republican leaders could derail the movement. In a letter, they urged the new administration and congress to “affirm their support for the transition to value-based care that reduces cost, improves quality, and more sharply focuses on patient needs.”

Kaiser Permanente CEO Bernard Tyson is optimistic that value-based care is here to stay. Kaiser, which pioneered the model, is expanding across the country because of their confidence that the benefits will be proven.

“At the end of the day, people are demanding value,” says Tyson. “…People want more transparency about what’s going on with the cost of care and the value that they are getting with the health care system around the country. That’s going to continue.”

How do you think a Trump healthcare plan will impact your organization? Let us know in the comments below.

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