The future of the ACA: Making sense of health care reform

With President-elect Donald Trump and congressional Republicans planning to “repeal and replace,” the new session of Congress that began this month is expected to be marked with major changes to the Affordable Care Act. While repeal of some of the law can be achieved with Republican votes alone, bipartisan support will be required to clean up significant provisions and replace them where required — leaving many questions to be answered. 

What is ACA repeal?
Many people might think that ACA repeal means completely unwinding the Affordable Care Act. Unfortunately, this is not the case with the current debate. Divisions in Congress, procedural constraints and the need to provide for a transition period means that a more step-by-step approach is required. The end goal will be the same — replacing the old ACA with a new set of reforms. It just takes a little longer to get there.

What is the significance of budget reconciliation to ACA repeal?
Budget reconciliation allows Senate passage of an ACA repeal bill with only a simple majority of 50 votes to pass the Senate, rather than the 60 votes required to pass most Senate legislation.

Which ACA provisions are expected to be changed, modified or removed?
The tradeoff for simple majority passage in the Senate is that the reconciliation bill must be limited to issues with a direct revenue impact. Thus, the employer and individual mandate provisions of the ACA cannot be directly repealed — but the penalties for non-compliance can be reduced to zero. Benefit requirements and insurance market provisions cannot be repealed, but ACA taxes such as the Cadillac tax on benefits, the health insurance, medical device and pharmaceutical taxes can be. The Medicaid expansion can also be repealed.

What is the expected impact on retailers and the business community?
What remains of the ACA could be a very uncomfortable patchwork. Employers will no longer need to offer coverage after repeal but will still have to comply with many remaining ACA provisions, whether they offer coverage or not. NRF and allies are continuing to work hard to ensure that the legislation passed is created in as much of an employer-friendly manner as is possible.

Health care reform is anything but a simple process, but you can get involved to make a difference in this debate:

  • Join Your Peers NRF’s Health and Employee Benefits Committee is squarely focused on repeal and reform of the ACA. Join the HEBC committee and our monthly teleconferences for up-to-date information and additional steps to get involved.
  • Write Congress – Let them know that retailers have worked hard to fix and adjust to the ACA but the law is still very much of a burden. We want a new health care law that protects employer-based coverage and keeps it stable without benefit mandates. True health care reform should reduce the cost of medical care and coverage and ease employers’ compliance burdens.
  • Come to Washington – Watch for calls to action. We may call you to come to Washington at key junctures to help Congress understand retail’s unique concerns. NRF’s Retail Advocates Summit in July may be another good opportunity.