The Affordable Care Act is headed for the dust bin shortly after Donald Trump takes office as president, but its repeal will likely affect individual policy owners rather than groups, said Robert Hartwig, clinical associate professor of finance at USC’s Moore School of Business.
“It will be a symbolic repeal,” Hartwig said. “It will take a couple of years to do the real dirty work.”
Group health policies that have been negotiated by businesses will likely remain about the same, Hartwig said, as many aspects of the Affordable Care Act are rolled back.
The mandate for individuals to purchase health insurance will be eliminated, along with related penalties for non-coverage, Hartwig predicted.
Likely to stay is the provision allowing children to remain on their parents’ coverage until age 26. Also, those with pre-existing conditions will be covered, although there will be modifications to the way this coverage is handled, Hartwig said. Some people with pre-existing illness may be moved into a high-risk pool for coverage.
As changes to health care policy are phased in over the next two to three years, look for provisions to allow insurers to sell policies across state lines, privatization of Medicare, expansion of Medicaid and expansion of Health Savings Accounts, Hartwig said.
The prohibition on dollar limits for lifetime and annual coverage are also like to be eliminated. “They will go,” Hartwig said, as well as guaranteed access and renewal of health coverage.
“Underwriting restrictions will be lifted to restore competition,” he said.
As the essential health benefits requirement goes away, “there will be more choices,” Hartwig said. The ACA required that a health insurance policy cover pregnancy, maternity and newborn care; pharmaceuticals; rehabilitation services; and preventive services, among other items.
Without this requirement, insurance companies can sell policies that cover fewer services at a lower price.
The health insurance marketplace will change significantly. “The state exchanges will go and the ACA’s advance premium tax credits will go,” Hartwig said.
“The bottom line is that the campaign promise to ‘repeal and replace’ Obamacare will be implemented as something more akin to a reform and restructuring effort rather than a complete repudiation of President Obama’s signature legislative achievement,” he wrote in a column for Best’s Review.