The Trump/Pence website makes no bones about it: repeal the Affordable Care Act (ACA, also known as Obamacare), which covers an estimated 22 million Americans.
However, for now, the ultimate fate of the legislation remains to be seen. Although whispers and rumors abound, the program may not be repealed or replaced in its entirety. Most likely, there will be significant changes to the program if it survives, due to an adamant, hardline Republican President and Congress, who have opposed the Act from the very start.
Here are the elements of the ACA that are being considered for repeal:
- Preexisting conditions: Under the Affordable Care Act, health insurance companies cannot refuse coverage for a preexisting condition, nor can they charge higher rates. These conditions include (but are not limited to) asthma, diabetes and cancer. Insurance companies are also currently not allowed to charge more for women than for men.
- Remaining on parents’ plan until age 26: Before this law, insurance companies could remove children from their parents’ plan at various ages. Often, the cutoff date was age 19, and sometimes older for full-time students. Under the Affordable Care Act, parents could keep their children on their health insurance policy until age 26. Children could join or remain on their parents’ plan even if they are married or not living at home, and even if they are not financially dependent on their parents.
- Prohibitions on annual and lifetime limits on essential health benefits. The Act prohibits health plans from putting annual or dollar limits on most essential health benefits, like ambulatory patient services, prescription drugs, flu shots, pregnancy/newborn care, and mental health and substance abuse disorder services. Before the ACA, many health plans put a dollar or lifetime limit on certain benefits, and the enrollee was required to pay all costs after that cutoff. Note that this ban does apply to certain procedures that are considered non-essential, like orthotics, hearing aids, acupuncture, and chiropractic visits.
- First-dollar coverage for preventative care services. For now, under the ACA, the insurer is responsible for all preventative services expenses up to a maximum amount. In other words, the health insurer pays first – there is no co-pay. These include preventative services such as breast and colon cancer screenings, as well as screenings for diabetes, high cholesterol and high blood pressure.
- The “Cadillac” tax: On December 18, 2015, Congress passed and the President signed a two-year delay of the 40% excise tax on high-cost employer-sponsored health plans, nicknamed the “Cadillac Tax.” Although this tax was originally non-tax-deductible, the December 2015 legislation made it deductible for employers who pay it.
- The individual mandate: This mandate requires most Americans to obtain and maintain health insurance, or an exemption, on a monthly basis. Those who do not must pay a tax penalty. The penalty for not having health insurance must be paid through Federal Income Tax Returns. In 2016, the annual fee for not having insurance in 2016 is $695 per adult and $347.50 per child.
- The employer mandate: This mandate was set to begin in 2014 but was delayed until 2015/2016. It requires that all businesses with 50 or more full-time equivalent employees provide health insurance to at least 95% of their full-time employees and dependents up to age 26, or pay a fee. Note: spouses do not count as dependents, and coverage does not have to be offered to spouses. According to Treasury.gov, approximately 96% of employers are small businesses and have fewer than 50 full-time-equivalent workers – making them exempt from this requirement.
The reality: just about every Republican and conservative legislator has publicly voiced commitment to repeal of the ACA, desiring to eliminate nearly all ACA reforms for private health insurance. Alternative plans are being considered as well, but more news will become known once power shifts in Washington starting in January 2017. We’ll keep you posted.