Independent Health is closely following plans by the Trump Administration and Congress to address the future of the Affordable Care Act (ACA) and will keep our customers up-to-date on developments. We provide this latest overview in our occasional series of ACA updates.
February 20, 2017 Update:
HHS Secretary Confirmed; Access & Affordability Review
Confirmation of Dr. Tom Price
Georgia Representative and physician Tom Price was sworn in on Feb. 10 as Secretary of Health and Human Services (HHS) following a Senate confirmation vote of 52-47 earlier that morning. Secretary Tom Price has served in Congress since 2004 and also practiced as an orthopedic surgeon before entering politics.
As secretary, Price is responsible for the administration of Medicare, Medicaid, and other health programs and oversees a broad range of HHS agencies, including the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare & Medicaid Services (CMS). He has been a consistent opponent of the ACA while in Congress, even offering his own replacement legislation, the Empowering Patients First Act, which included numerous provisions, including a full repeal of the law.
Other provisions in his proposed legislation included refundable, age-adjusted tax credits for health insurance; promotion of Health Saving Accounts (HSAs); prohibition on federal abortion funding; and the allowance of interstate sale of health insurance.
Market Stabilization Proposal
On Feb. 15, the Trump Administration issued a proposed rule designed to stabilize the individual and small group health insurance markets. Although the proposed rule begins to address market stability concerns, it does not appear to resolve all the uncertainty for both plans and patients. Health policy experts are closely assessing the proposed rule, which is now in the public comment phase until March 7. Once finalized, some of the provisions could take effect this year, but more would take effect in 2018. As more details on the proposed rule are known, Independent Health will discuss this in a future ACA update.
ACA Provision Review
As the Trump Administration and Congress consider alternatives, proposals to replace the ACA will have to address key components, such as:
- Access and Affordability
- Individual mandate (1/23/2017 Update)
- Medicaid expansion (2/3/2017 Update)
- Taxes and penalties
- Delivery system reform
- Drug costs
Each issue of the ACA Update will revisit a key provision from the ACA that will likely be repealed as part of the process to replace the ACA. This Update covers access and affordability.
Access and Affordability
The primary goal of the ACA was to improve access, coverage and affordability in a previously unstable health insurance market. To achieve expanded access of health care coverage, the ACA included several market reforms and consumer protections, such as:
- Elimination of lifetime or annual limits;
- Coverage for preventive health services;
- Coverage for dependent children up to age 26 on their parents’ policies;
- Guaranteed availability and renewability.
To make coverage affordable, the ACA provides:
- Tax credits to individuals and small businesses;
- Cost-sharing subsidies to individuals.
As Congress and the White House craft replacement plans for the ACA, they will have to address access and affordability. At this point, it is unclear how those two key concepts will be handled, and whether or not ACA tax credits and subsidies will be replaced, maintained or modified in order to keep coverage affordable.
Proposed alternatives to the current subsidies and tax credits include:
- Expansion of Health Savings Accounts (HSAs). Some proposals would eliminate the current HSA contribution limits, allow the ability to use HSA funds to pay for insurance premiums, and eliminate the requirement to be enrolled in a high-deductible health plan in order to have an HSA.
- Revise current ACA tax credit structure: for example, tax credits could be age adjusted or portable.
Although the ACA has resulted in providing access to coverage to more than 20 million Americans, rising health care costs and the affordability of the law remain as concerns. For our part, Independent Health will continue to work collaboratively with key stakeholders on programs and initiatives to advance to a future of quality, accessible and affordable coverage.