By Chris W. Durkin, RHU, REBC, President and CEO of FBC Insurance, Benefits & Consulting
A frequent question we hear is how a new administration would handle healthcare in America and specifically the Affordable Care Act provisions. What will Trump or Clinton do to solve our healthcare puzzle?
Healthcare in America is a continuing topic of great concern since it equates to 17% of our Gross Domestic Product. After watching 8 presidents occupy the White House while in the employee benefits business, I can tell you there have been some big changes over that time. We have had a continued expansion of Medicaid, increased taxes to support Medicare, a failed national healthcare plan during the Clinton administration, and healthcare inflation outpacing overall inflation, year-after-year. One of the most significant changes, however, is the Affordable Care Act.
What is the Affordable Care Act?
The Affordable Care Act—or “Obamacare,” as many, including the president himself, like to call it—is the biggest piece of healthcare legislation since Medicare was established in 1965. For some, it’s a blessing. For others, it’s incredible pain in the neck—or wherever. One thing we say around here is “There is nothing affordable about the Affordable Care Act”.
The ACA essentially does 3 things:
- Expands Medicaid, a federally and state-supported healthcare program for those who fall below the Federal Poverty Level.
- Creates a scaled tax subsidy for those between 133% and 400% of the Federal Poverty Level to help them pay for health insurance.
- Imposes significant tax and compliance burdens on businesses and individuals to pay for these new programs.
Where do the candidates stand on healthcare?
The questions we hear are generally aimed at what each candidate would do to the law to make healthcare costs and insurance premiums more affordable. Here is a quick summary:
Hillary Clinton has said she would basically want to keep the law as is, but is open to making modifications which make sense—a pretty standard answer for someone who does not want healthcare to be her cornerstone issue in this election.
She has floated the idea of allowing age 55 and older individuals the chance to buy into Medicare early (before age 65). I personally like this idea in concept, provided it requires a realistic cost assessment of Medicare and does not increase our national debt by transferring costs to the tax base. However, I don’t see this becoming law any time soon. If Hillary gets elected, don’t look for any changes in the ACA.
Donald Trump has a lot of interesting things to say, and one of my favorites was that he would repeal the ACA and replace it with “something wonderful”. There has been a consistently strident voice in America to repeal the ACA, but few specifics on what it would be replaced with. Jeb Bush offered a specific plan, as did James Capretta with the American Enterprise Institute.
It is complicated to construct an alternative which addresses the features of the ACA (some of which have 85%-plus favorability ratings, like the elimination of pre-existing conditions and no more answering health questions) and come up with “something wonderful”. If Donald Trump becomes president, there is some chance the compliance burdens of the ACA may be improved but very little chance the law will fundamentally change.
If there is one thing I have learned in almost 40 years of watching politics from my perspective is that it is unpredictable. So, stay tuned!
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