Repeal, Replace, Re-mind me why I care?

Ok, you’ve seen it flashing on the news and in your emails. President Trump is doing away with ObamaCare and they’ve created a brand spanking new healthcare plan. Who cares? Well actually, after reviewing the proposed changes there are a couple of points you should know about if you are a healthcare operator.

So, instead of you having to read the Plan details yourself, we figured we’d give you the highlights here briefly, then you can get back to work!


  1. There are a few things NOT changing.

Here they are:

  • Insurers will still have to cover preexisting conditions
  • Insurers will still have to cover Adult children until age 26
  • Insurers will still have to give out of pocket limits
  1. Introducing Medicaid Per Capita Caps.

This means the Federal Government will give a grant, sort of like an allowance to each state. This cap amount would be based off how many Medicaid qualified individuals are in the state for the year. It would then increase annually based off the medical inflation rate. Many provider advocates feel this will not be sufficient to cover the gap that Medicaid rate increases and increased provider assessment may have offered previously.

  1. Who is eligible for Medicaid?

ObamaCare allowed for anyone under the 138% poverty level to be included in the Medicaid program. The new plan reverts back to limiting this to children, pregnant women, elderly, and disabled. Anyone already on the program will be grandfathered in, and remain covered.

  1. What are the big changes for insurance?

So, good news/bad news, we’ll start with the bad. The new plan allows for insurers to raise the premiums by 5x, for older customers. On the bright side, older customers will get twice the amount of tax credits annually of $4,000 per year.

  1. If Insurance and Medicaid are both changing, Managed Medicaid definitely is.

That’s correct. The EHB (essential health benefits) that were mandated that Managed Medicaid plans must offer, is now being removed. Some of these required benefits were mental health and substance abuse treatment, pediatric services including vision and oral care, and rehabilitative services and devices.

  1. Anything Else?

Yup. In December, the plan is to roll out some more significant changes. An important one being the allowance for insurers to expand over state lines. This would lead to much more competitive market, and less control by insurer over providers.