It’s Complicated: ACA Status

February 10, 2017

During an interview that aired on Super Bowl Sunday, President Donald Trump’s projected timing regarding a replacement for the Affordable Care Act (ACA) differed from his estimate in early January. Initially, he indicated that the ACA would be repealed and replaced as soon as Rep. Tom Price, MD (R-GA) is confirmed as Secretary of Health and Human Services (HHS) (which happened early this morning). Trump’s latest projections for a new program are “…by the end of the year, at least the rudiments, but we should have something within the year and the following year.” He referred to the complexity of the work at hand and recognizes it will take time to complete the process.

Press Secretary Sean Spicer elaborated on those comments during his press briefing on Tuesday, acknowledging that the repeal-and-replace could be done “sooner than 2018,” but “the implementation of a lot of the pieces may take a little bit longer.” He reiterated that Trump would provide Americans with “a lower-cost health solution with more options, [because that’s] what they were promised in the first place.”

As we have discussed in previous issues, the act of repealing and replacing the ACA isn’t easy. Republicans have been discovering it is much more difficult to agree on what the replacement will be than it is to simply advocate repealing the healthcare law. In addition to the political sausage making, there is the tremendous difficulty unwinding the tendrils of the ACA’s law and regulations from US healthcare without compromising coverage and access for millions of Americans. Now that Secretary Price has been confirmed (see next story), will we see him drive the repeal-and-replace effort? Or is the Administration backing away and hoping that Congress takes over?

Also this week, Politico received leaked documents describing potential rule changes to the health insurance exchanges being considered by the Administration. The draft documents, if implemented, would alter the exchanges as follows:
  • Insurers can now charge older, more expensive customers 3 times as much as younger enrollees. The draft rule would increase that ratio to 3.49:1, so insurers would be able to charge older customers more
  • The 2018 Open Enrollment period would be cut in half, from November 1 to December 15, rather than to January 31, 2018 as scheduled by the Obama Administration
  • Qualifications for allowing customers to purchase plans outside of Open Enrollment (ie, during “Special Enrollment” periods) would be tightened
  • The range of out-of-pocket costs would be widened, to the benefit of consumers. For example, insurers would be required to cover between 66% and 72% of medical expenses for a silver plan, compared to the current range of 68% to 72%
  • The 90-day grace period for enrollees who stop paying premiums, but still have insurance coverage, would be tightened
The changes, in general, are supported by the insurance industry and opposed by consumer advocates. The Administration is attempting to keep insurers, such as Aetna, from fleeing the exchange marketplace due to losses of hundreds of millions of dollars.

Health Policy Weekly is written by Xcenda, a consultancy and business unit of AmerisourceBergen Specialty Group. Visit Xcenda’s online archive to access more health policy news.

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