What’s Happening to the Affordable Care Act?

Confusion. Frustration. Fear. We’re all feeling something towards the uncertainty surrounding health insurance right now. Let me try to relieve some of it by explaining what has happened and how we should respond.


With the Affordable Care Act currently in a state of flux, we must ground ourselves with facts. Here’s what we know for sure right now:

  1. The ACA is a law passed by Congress. Only Congress has the power to change a law.
  1. There were many regulations promulgated by the Department of Health and Human Services (DHHS) over the past five years to support portions of the ACA law (ex. specifying the Essential Health Benefits that all plans must cover). These rules can change, but only through a fairly long and formal rulemaking process.
  1. A small army of legal organizations are ready to file lawsuits to stop any action by the President, Congress, or any other official that oversteps their legal authority. Government officials and health insurers cannot ignore current, active law.
  1. President Trump issued an executive order last weekend (Jan 21st) ordering all federal agencies to “take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the [Affordable Care] Act.” While there is little actual functional value to the executive order (see #1 and #2 above), it reinforces the President’s stance against the ACA and asks Executive Branch employees to work towards limited the law’s effect. It doesn’t actually do anything on its own. At most, the IRS director could use it as reason to not levy the tax penalty on uninsured individuals.

  1. Health insurance plans in effect on January 1, 2017 will be virtually unaffected by any change in law, as a matter of contract law. Your 2017 insurance plan is a contract, and insurers will have no incentive to break that contract (you would be able to sue them to get the benefits; it would be bad for them). It took several years to phase in the ACA, and we should expect the same if it is to be phased out; expect any changes to apply on January 1, 2018 at the earliest.


So how does all this affect you? What should you do? Consider the following:

  1. Stay the course – If you are an employer or a benefits manager, I highly recommend following the Society for Human Resource Management’s (SHRM) guidance to continue with business as usual until we hear otherwise. We don’t know whether anything will change or how much it will change. It is a bad idea to make preemptive policy and benefits changes without knowing what is actually happening.
  1. Stay covered – As an individual, you shouldn’t worry too much about your 2017 health insurance coverage. DO NOT avoid getting coverage because you think the tax penalty is going away. Get coverage so that you have protection from health and financial risk; health insurance existed long before the ACA, and it will be here long after the law is changed.
  1. Let politics be politics – At this point in time most government agencies, health care providers, and insurance carriers are continuing with business as usual in their planning efforts for 2018. They will likely not make any changes to their business models or strategies until actual changes to the law are made.

There is no incentive for insurers or agencies to preempt laws or regulations that have not been enacted. Much of the debate and discussion around the ACA will end up as conjecture and argument. Let politics happen and react if and when decisions are made. DHHS doesn’t even have a confirmed leader yet.

  1. Get involved – If you are concerned with how certain changes in the law could affect you (especially if a proposal would negatively impact you), I recommend contacting your state and federal government representatives. Tell your Congressional representatives how you feel and what you want them to do about health insurance before they make their decisions.

At least one state (Maryland) has large portions of the ACA written into state law, so an ACA repeal will only slightly affect residents there. Other states have some insurance regula

tions in place that go above and beyond the federal mandates (Michigan does not). Ask your state lawmakers to write the ACA provisions that are most important to you into state law.

  1. Plan ahead – If you have a pre-existing health condition (ex. diabetes, a chronic illness, etc.) or you receive special health services that the ACA made less expensive (ex. cancer treatments, maternity care, etc.), then I recommend watching your budget a little more closely this year.

If the ACA is repealed without similar replacement protections, you could be facing significantly larger health care costs in 2018. Do what you can to save money this year to help pay for possible coverage changes next year. At worst, by working to save a little more this year you’ll have a mini vacation fund in 2018 if the ACA remains intact.

Health care, and by extension health insurance, is important to all of us. It’s certainly a complicated and frustrating time for everyone, regardless of how you feel about the Affordable Care Act. Stay calm, remain aware, and get involved if you feel so inclined; but most importantly, we just have to wait and see what happens.

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