A perfect storm is brewing, and it could spell the beginning of the end for the Affordable Care Act.
Conditions include a Republican-controlled House, Senate and White House, combined with President-elect Donald Trump’s nomination of Georgia Congressman Tom Price as secretary of Health and Human Services. Price, a six-term congressman and orthopedic surgeon, has introduced counter-legislation to Obamacare each year since it passed. His recommendations have contributed significantly to the “A Better Way” health care agenda. A Better Way is a policy map adopted by Republicans in Congress earlier this year, also addressing topics such as national security, poverty and tax reform.
Trump spoke of repealing and replacing the ACA during the presidential campaign, but offered few specifics. Republicans, however, are beginning to piece together a vision of a post-Obamacare world, but timelines and alternatives have been sparse or nonexistent. National, state and regional health care experts — and about 20 million people insured under the ACA — are anxiously awaiting direction from the president-elect and his administration regarding the future of Obamacare.
STILL BREAKING RECORDS
The GOP gained fodder late in the election season thanks to the October release of expected ACA 2017 premium hikes. During this year’s open enrollment period in Colorado, which ends Jan. 31, health exchange consumers have seen premiums increase about 20 percent, a bit below the national average of 25 percent.
Despite the price hike, in the first month of open enrollment, Coloradans selected 37,948 medical and dental insurance plans. That compares to 30,777 plan selections in November 2015.
And Coloradans purchasing insurance through Connect for Health Colorado, the state’s exchange, were luckier than many counterparts. People in Alabama, for example, saw premiums increase 36 percent and Georgians encountered a 32 percent hike. Those insuring through the Illinois exchange can expect a 44 percent premium cost increase next year and, in Minnesota, premiums are expected to jump by as much as 67 percent. Minnesota’s commerce commissioner is on record saying the individual marketplace is “on the verge of collapse.”
The Affordable Care Act, many argue, is growing far less affordable. And the newly elected administration has vowed to do something about it. But what?
“The difficulty right now is, it’s all just conjecture,” said Vincent Plymell, Colorado Division of Insurance communications manager. “We’re getting a lot of different signals, mixed signals from the new administration. After Trump met with [President] Obama, he said he wanted to keep ‘these’ parts and do away with ‘these’ parts.”
Plymell said the ACA is still law, and operations at the DOI will remain status quo.
“We certainly encourage people to continue with open enrollment and sign up for insurance,” he said. “It’s unlikely something will happen right away and having insurance is always better than not having insurance.”
Consumers appear to be heeding that advice. The Colorado marketplace has seen an increase in ACA enrollees, including a 50 percent jump on opening day compared to a year ago.
According to numbers provided by Connect for Health Colorado, “more than 37,000 Coloradans selected health care coverage for 2017 through the state health insurance marketplace in November, a rate 23 percent ahead of sign-ups one year ago.”
Scenarios have been played out at the DOI regarding the new administration, Plymell said, to include what would happen if subsidies and tax credits were changed or eliminated, or if there were adjustments to the individual mandate or to the policies of those consumers with preexisting conditions. Trump said covering those with preexisting conditions is an aspect of Obamacare he supports.
“We have to consider if those go away or if they’re changed in some way, shape or form,” Plymell said.
Katherine Mulready, vice president of legislative policy and chief strategy officer with the Colorado Hospital Association, said Colorado hospitals are doing everything they can to prepare, “but the key is the unknown. We’re taking [Trump’s] campaign promises to repeal and replace [the ACA] very seriously, along with our colleagues in the industry.”
Mulready said the CHA will advocate for pieces of the ACA that should be part of any replacement plan.
Medicaid expansion, which Mulready said was important to Colorado voters prior to the ACA’s passage, is one of those pieces.
“We’ll push a replacement plan that won’t deprive people of the coverage they’ve obtained over the last several years,” she said.
Those in charge of Peak Vista Community Health Centers in Colorado Springs have also been waiting for a definitive course from the new administration.
“Hurry up and wait sums it up well,” said Peak Vista President and CEO Pam McManus. Peak Vista provides care to underserved and at-risk populations and relies heavily on Medicaid payments. But Congressman Price has publicly opposed Medicaid expansion.
McManus said, whatever the fate of the ACA, “we’ll continue [serving that population] no matter what. We’ll stay true to our mission of being a safety net.”
David Pump, vice president of business development for Peak Vista, said developing a strategy has been difficult.
“The Affordable Care Act is complicated,” Pump said. “We’re not sure what’s going to happen. The key for us is, while there likely will be changes in federal policy that will have an impact, when it happens, will we be ready to take care of our patients and the community?”
Managing health care often means dealing with the unknown, McManus said.
“There are continual changes in health care. … I think one important thing is that the community work together and collaborate to make a difference for the patient,” she said.
According to figures provided by the U.S. Department of Health and Human Services, more than 80 percent of those purchasing insurance through an ACA marketplace nationwide receive some sort of subsidy. Figures compiled by Connect for Health Colorado showed more than half of Coloradans receive coverage through employers and about 60 percent qualify for subsidies. And despite varied coverage and payment options in most areas, residents in 14 Colorado counties will, for the first time in 2017, have only one choice through the exchange.
Luke Clarke, director of communications at Connect for Health Colorado, said some of Trump’s general campaign proposals could affect local choice and cost, to include his endorsement of tax-free health savings accounts that would allow deducting the cost of premiums from income tax returns. Trump has also advocated allowing marketplaces to sell policies across state lines to boost competition.
Clarke admits there are many unknowns, but said one thing is for sure: Plans purchased during this open enrollment period will be valid no matter what happens in 2017.
“We’re trying to get the message across to all Coloradans buying their own insurance: Rest assured. The coverage you buy today will be in place and unchanged through 2017.”
Regarding a CBS “60 Minutes” interview in which Trump said no matter the replacement for the ACA, there won’t be gaps in coverage, Clarke said, “That’s realistic. It can be done. I heard that and, personally, I found it encouraging.”
According to Paul Prentice, the only good ACA is a dead ACA.
Prentice is a professional economist in Colorado Springs. His resumé includes a fellowship at the Centennial Institute at Colorado Christian University, a senior fellowship with the Independence Institute and acting as an associate scholar at the Ludwig von Mises Institute in Alabama. He also worked in the Department of Agriculture during the Reagan administration.
The ACA has had two “major depressing effects” on the economy, Prentice said.
“Rather than decreasing premiums, it ended up increasing them and draining consumer power,” he said. “But an even more insidious impact on businesses is, many have had to cut employee hours to 29 a week to avoid being subject to ACA mandates. It destroyed a lot of full-time employment and replaced it with part-time.”
The ACA has played a role in the nation’s “weak recovery” following the Great Recession, he added.
“There have been a lot of headwinds preventing the economy from recovering as strongly as it should from the recession,” he said.
Prentice is optimistic, though, following the results of this year’s election.
“I believe [the ACA] is going to be repealed,” he said. “It was one of Trump’s main campaign promises, and he has the support of Congress, which has tried to repeal it several times. I believe something more market-based will take its place.”
Prentice said he also supports tort reform in health care, which will be even more important if marketplaces open across state lines, as proposed.
When asked if he supports any aspects of the ACA, Prentice was to the point.
“I don’t. Trump likes the idea of keeping adult children through age 26 on their parents’ plan. … I don’t think we need that kind of control out of Washington [D.C.].”
He also said he is “very much against” insuring those with preexisting conditions.
“It’s like shopping for fire insurance for your house while your house is on fire. That’s not insurance, that’s welfare transfer,” he said. “It adds to overall costs.”
As for a safety net, Prentice said that’s also not the role of government.
“It’s not the government’s job to help people. It’s up to people to get insurance,” he said. “We have the right to pursue happiness — not achieve it. That’s up to us. Grow up and get your own insurance.”
Plymell said the health insurance landscape can be confusing for employers and individuals. The DOI is available to answer questions — a service that is woefully underutilized.
“Since the ACA came into full being in 2014, there’s an increase in importance of being aware of and exploring options,” he said. “This is true if things change or not. The days of auto-renewing the same plan every year, that’s gone because even if the Affordable Care Act doesn’t change, plans change; carriers change.”
And consumers often don’t know what questions to ask, Plymell said.
“We welcome people contacting us and asking those questions,” he said. “Many think they can only call to file a formal complaint. No. We’ll tell you what a word means or why an insurance company denied a claim. Those are questions we want to hear. We hope people will use us more, especially as changes come down over the coming years.”
Those with questions may contact the Colorado Division of Insurance at 800-930-3745 or 303-894-7490, or email firstname.lastname@example.org.