The ballots have been cast and Donald J. Trump will be occupying the Oval Office come January. Many employers have looming questions about what changes are on the horizon - especially when it comes to healthcare.
According to www.donaldjtrump.com, President-elect Trump's vision for health care includes the following:
- Repeal and replace Obamacare with Health Savings Accounts (HSAs).
- Work with Congress to create a patient-centered health care system that promotes choice, quality, and affordability.
- Work with states to establish high-risk pools to ensure access to coverage for individuals who have not maintained continuous coverage.
- Allow people to purchase insurance across state lines, in all 50 states, creating a dynamic market.
- Maximize flexibility for states via block grants so that local leaders can design innovative Medicaid programs that will better serve their low-income citizens.
Trump campaigned on the full repeal and replacement of the Affordable Care Act. That may prove difficult since Republicans do not have a 60-vote supermajority in the Senate and cannot outright repeal the ACA. Democrats would be able to filibuster any ACA repeal and replace plan. However, Republicans could use a process known as reconciliation, which requires only 50 votes in the Senate, to eliminate many of the law's key provisions.
Last year, the Senate passed a reconciliation bill that undid large portions of the health bill. The House passed it, but President Obama vetoed it.
The First 100 Days
Any new legislation in the first 100 days of the Trump administration may look just like the bill that President Obama vetoed (Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015). Republicans will most likely push new laws that include a two-year phased in approach to:
- Eliminate ACA programs that provide Medicaid coverage for Americans near or below the poverty line.
- Eliminate subsidies to help middle-income Americans buy their insurance on new marketplaces.
- Eliminate tax penalties for the uninsured, meant to urge everyone to obtain health insurance, and
- Eliminate some taxes created by law to help fund those programs.
Republicans have not reached a consensus on what a replacement plan would look like or how this would work. Repealing the ACA without any replacement plan could mean more than 20 million individuals lose their health insurance coverage. That could spell trouble for the many Republicans in Congress who are up for re-election in 2018. Those up for re-election will most likely not support a repeal without a replacement plan.
Expect Republicans to use the strategy mentioned above of leveraging reconciliation to repeal much of ACA (including Medicaid expansion and subsidies on exchanges) and delay the repeals going into effect for 18 or 24 months. During this period they will attempt to work with Democrats to come to a consensus on a replacement.
ACA Excise Tax (Cadillac Tax)
President-elect Trump also supports the repeal of the ACA’s Cadillac tax. The 40% Cadillac excise tax on employer plans (exceeding $10,200 in annual premiums for individuals and $27,500 for families) is scheduled to go into effect in 2020. President-elect Trump may also use this to weaken the ACA. Many Democrats in Congress are also for repealing the Cadillac tax since it hits Union plans the hardest, but they will have to weigh the benefits of repeal against adding to the Affordable Care Act’s costs. Repealing the Cadillac tax would remove projected revenues of $76 billion through 2026. The Cadillac repeal will add to the Affordable Care Act’s overall costs.
Paid Family and Medical Leave
President-elect Trump campaigned on a plan to guarantee six weeks of paid maternity leave to mothers. This new benefit would be worth an average of $300 weekly. This paid benefit would be for mothers only and would not extend to fathers, adoptive parents, or caregivers who taking care of other family members who are ill.
Child Care Expenses
President-elect Trump has also proposed to let working parents deduct child care expenses for up to four children and elderly dependents. He also plans on establishing dependent care savings accounts.
Only time will tell if President-elect Trump will be able to create a bipartisan coalition to move his agenda forward. He will need both parties to work with him. If he cannot find common ground, Democrats in Congress will make moving his agenda a difficult proposition.