With GOP repeal initiations underway, brokers anticipate ACA replacement

Despite action this week to begin repealing the Affordable Care Act, questions remain over whether the Republicans in Congress can both repeal the ACA and replace it with their own alternative by the end of February — without creating a gap in health coverage for Obamacare’s roughly 20 million participants.

“Having plan and executing on the plan are two very different statements. [President-elect Donald Trump] says he wants to have a plan by the end of February and I think the assumption is what the timetable of the rollout will be to get that done,” says Perry Braun, executive director of Benefit Advisors Network.

The Republican-led U.S. Senate took its first steps to repealing the ACA by voting to remove funding from the health insurance law. The vote — 51 to 48 — was mostly along party lines. Sen. Rand Paul (R-Ky.) voted against the measure due to concerns that Republicans have not settled on a plan to replace the ACA. (Democratic Senator Barbara Feinstein (Calf.) did not vote as she was recovering from surgery.)

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The House of Representatives will vote on the measure today.

At a Wednesday press conference, President-elect Trump reiterated plans to repeal the ACA and replace it by the end of next month.

"We're going to be submitting, as soon as [HHS Sec. nominee Tom Price] is approved, we'll almost simultaneously — shortly thereafter — have a plan. It will be repeal and replace. It will be simultaneously," said Trump on Wednesday.

The President-elect added that a plan to replace Obamacare will be revealed after he takes the Oath of Office on Jan. 20 and the Senate approves his nominee for the Secretary of Health & Human Services, Rep. Tom Price (R-Ga.). Price is a doctor who has also proposed his own version of a health insurance plan to replace the ACA.

BAN’s Braun doubts that the rollout to a new health plan will be immediate. “If we use the implementation of Obamacare as a guide, it took several years to roll out the provisions. I will say that I thought the administration was very, very smart in its rollout in that many of the heavier items that were financially or stakeholder-sensitive were loaded on the back end of the term, rather than in the beginning of the term,” he says.

Other benefit industry reps are optimistic, despite the lack of details from the incoming administration and the newly sworn-in, GOP-led Congress.

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”Although imperfect, the Affordable Care Act contains many provisions that benefit the health and wellness of Americans. As Congress and the incoming Administration work in haste to repeal the ACA, we hope they will recognize and preserve the positive aspects of the law. We are encouraged by the incoming Administration’s commitment to consumerism through the proliferation of pre-tax health spending accounts, as we believe this will continue to bend the curve of health care costs,” says Harrison Stone, general counsel and compliance officer at ConnectYourCare.

Stone adds, “We hope Congress and the incoming Administration will work in concert to improve our health care laws — ultimately providing all Americans with more affordable and accessible healthcare services.”

According to Bobbi Kloss, of BAN, clients of the broker are asking questions about the repeal of the ACA and are seeking clarity amidst the lack of details from the incoming administration.

“Yes, we are starting to get some questions, and we have been since the end of the election. We tell them they still have compliance that needs to be maintained and we tell them there are deadlines in place that they [must meet] and the changes will not happen overnight,” says Kloss.

“This is not the first time we have had a new administration in the White House. [Our clients] understand that things take time. Nobody knew how the election was going to come out and it will take time. … When we know, there will be guidelines for what the next steps should be,” she says.

Uncertain future
Addressing the ACA as a “total failure” on the campaign trail and since its passage, neither Trump nor the GOP-led Congress has a precise plan in place to replace the health insurance program. It’s uncertain if the new Congress will start from scratch or create a plan out of elements from the various proposals that have been put forth by individual Republicans.

Further, it is uncertain if Trump will push for keeping other elements of the ACA that he said he wished to keep in an interview he gave to “60 Minutes.” He told correspondent Lesley Stahl he wanted to keep the pre-existing conditions protection and the provisions that allows adult children up to age 26 to stay on their parents’ health insurance plans.

“I could effectively argue that Republicans have several different plans [to replace the ACA] but haven’t necessarily created a single plan,” says Braun. “I haven’t seen a final, ‘Here’s what we are going to do’ out of any GOP leaders.” He adds that Speaker Paul Ryan (R-Wis.) and Rep. Price both have their own proposals, “so the GOP has had plans for programs just like some of the Democrats have had recommendations.”

That said, Braun says “the Republicans have not offered anything that says, ‘This is our approach and what we are going to do here today.’”

Braun admits that a concrete plan must be offered. “We must remember that hope is not a business strategy. There are a lot of Monte Carlo simulations and game theory and things that are happening in back rooms and across dinner tables. We have to address the here and now. As policies become fleshed out and implemented, then we have an opportunity to go forward in a thoughtful manner.”

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