Affordable Care Act Update - 12/20/16


Independent Health is closely following efforts by President Donald Trump and the Republican-controlled Congress to repeal and replace 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.

December 20, 2016 Update:
The Affordable Care Act’s Immediate Future

The election of Donald Trump as President has undoubtedly raised questions around the future of the Affordable Care Act (ACA). In the coming months, Independent Health is closely following national policy experts and will keep our employer customers up-to-date on developments. We provide this overview as the first in a series of occasional updates for you.

While it’s widely agreed that Congress will likely act soon after the new session begins in January to repeal ACA, aftereffects will not be immediate. Despite what lawmakers or the media may announce following such a vote, the law cannot be completely revoked through a one-time action by Congress.

In fact, Congress must follow a process toward the repeal of ACA. It is expected this process will begin by a budget resolution vote, which may come in January.

A budget resolution is not a bill signed by the President, but is a blueprint for Congressional committees to follow in order to repeal certain provisions of the ACA through a budget reconciliation process, which in turn involves a series of steps that will address the spending or subsidy provisions of ACA, and ultimately could take several months or years to fully implement. Many of the other ACA provisions cannot be dismantled through the budget reconciliation process, and therefore would require other Congressional action and legislation.

Because the ACA is a broad and complex law that encompasses Medicare, Medicaid, and group and individual coverage, experts agree it will be very difficult to eliminate or modify elements of the law without affecting other aspects, as many of the provisions in the law are connected with each other. Therefore, the repeal of ACA has a number of implications that Congress must consider when planning for a replacement, such as the fact there are 20 million people covered through the ACA, and the many patient protections that ACA guarantees.

Many health policy analysts believe Trump and the Republican-led Congress will seek to retain some of the popular provisions – such as coverage to age 26 and for pre-existing conditions – while eliminating other provisions such as the individual coverage mandate. Some of the proposals announced by President-elect Trump and House Speaker Paul Ryan include:

  • Allowing insurance to be sold across state lines;
  • Converting Medicaid into a block grant program, which gives states more control over the Medicaid program structure and benefits;
  • Reforming Medicare, such as increasing the eligibility to age 67 and creating a Medicare Exchange similar to the SHOP and Individual exchanges;
  • Providing tax credits for low-income beneficiaries instead of subsidies and expansion of HSAs.

Even if Congress puts forth the budget resolution, it will not affect Independent Health’s products and rates for 2017, so our small group and individual customers need not worry about their 2017 benefits.

This isn’t the first time the ACA’s existence has been in question. When ACA was brought before the Supreme Court in 2012 and 2015, Independent Health has always had an unwavering commitment to improve the quality, experience and affordability of care in the Western New York community.

We’ve long held the belief that health care reform legislation alone will not solve all the challenges facing our health care system, and the most sustainable health care solutions start at the local level. We have been actively developing and implementing initiatives with key stakeholder partners to transform Western New York into a high-value, high-performing health care community. Independent Health’s collaborative initiatives are working to improve health care by promoting prevention and wellness, revitalizing primary care, and enhancing our members’ experience through the RedShirt Treatment.

These local initiatives, regardless of what transpires on a national level, will allow us to focus on our continued goal of partnering with high performing providers to deliver the Triple Aim of better health, better care and lower costs for our members.