Possible ACA Repeal? Then What?

The November 8th elections were defined by widespread Republican victories. In addition to winning the White House, the GOP has control over the House of Representatives (238-194) and Senate (51-48). In light of the news, analysts are revisiting President-Elect Trump’s campaign positions on health care legislation. Trump has clearly articulated that repealing the Affordable Care Act (ACA) would be a top priority of his administration. More recently, GOP representatives showed some support for existing provisions of the Act, including coverage requirements for patients with preexisting conditions and coverage for children up to the age of 26. While ACA repeal-and-replace efforts are surely underway, insurers, employers and consumers are waiting in limbo for changes to a law that has been in place since 2010.

In anticipation of the November elections, the Foundation’s survey 2016 Employer-Sponsored Health Care: ACA’s Impact asked single-employer respondents a number of questions addressing the actions they may take if the law is repealed.

Possible ACA Repeal? Then What?
ACA repeal or not, our data shows employers and employees support keeping several provisions.

Previously Implemented Provisions

Respondents were asked how their organization would handle already implemented provisions of the ACA. About one in seven (14.3%) responding organizations stated that they would keep all of the implemented provisions in place. More than one in four (26.5%) would keep the majority of provisions in place, while over one in three respondents (36.8%) would keep some provisions while rescinding some. In addition, 6.1% of responding organizations would rescind the majority of provisions. Less than 1% of responding organizations support rescinding all previously implemented provisions of the ACA.

[Related: A Blueprint for Completing 1095-C Reporting To Make a “Good-Faith Effort”]

Top Provisions Employers Would Keep

Responding employers were asked which existing ACA provisions their organizations would want to keep if new legislation were introduced. The most popular provision for employers is the elimination of preexisting conditions exclusions, cited by 37.7% of respondents. Employers also support keeping:

  • Coverage of adult children to the age of 26 (31.4%)
  • Allowing increased wellness incentives (30.9%)
  • No cost sharing for preventive care in non-grandfathered plans (24.9%)
  • Elimination of lifetime dollar limits on “essential benefits” (18.6%)
  • Reporting, disclosure and notification requirements (12.8%)
  • Prohibiting waiting periods exceeding 90 days (12.3%).

Only one in nine (11.2%) responding organizations would not want to keep any of the listed ACA provisions.

ACA provisions employers want to keep

[Related: Inside the New Administration & Congress: What’s Next?]

Top Provisions Employees Would Keep

Similarly, employers were asked which existing ACA provisions their employees would want to be kept in possible new legislation. Results were relatively consistent, with two in three organizations stating that their employees would support keeping coverage of adult children to the age of 26 (65%). Employees would also support keeping:

  • Elimination of preexisting conditions exclusions (49.1%)
  • No cost sharing for preventive care in non-grandfathered plans (38.8%)
  • Elimination of lifetime dollar limits on “essential benefits” (22.6%)
  • Prohibiting waiting periods exceeding 90 days (12.1%)
  • Allowing increased wellness incentives (10.8%).

Only one in 12 (8.3%) responding organizations stated that their employees would not want to keep any of the listed ACA provisions.

ACA provisions employees want to keep

[Related: Eight one-hour online e-learning courses will help you stand out as your organization’s health care expert]

Anticipated Time for a New Health Care Bill

If ACA is repealed, respondents do not expect a new bill to be passed any time soon. Less than 5% (4.7%) of respondents anticipate that a new health care bill would pass in less than one year after repeal. Similarly, three in ten (29.1%) respondents anticipate that a new health care bill would pass within one to two years. One in four (24.4%) anticipate a three- to four-year period for a new bill passing, while 18.4% of responding organizations wouldn’t expect a new health care bill to be passed in five or more years.

During this time of uncertainty, one thing we can count on is that 2017 will be an interesting year for ACA! The International Foundation will continue to keep you on top of all the latest developments as they happen.

Justin Held, CEBS
Justin Held, CEBS
Senior Research Analyst/Educational Program Specialist at the International Foundation

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