In an article published November 9th on the Health Affairs Blog, Timothy Jost, Emeritus Professor at the Washington and Lee University School of Law and a member of the Institute of Medicine, cataloged the potential ramifications of what a Trump Presidency might mean for the Affordable Care Act. A summary of Jost's arguments are included below:
- Congress and the President can repeal many of the provisions that are identified by the public as “Obamacare” using the budget reconciliation process. A budget reconciliation bill can be passed by a simple majority and cannot be stopped by a filibuster.
- Trump has advocated tax deductions and tax subsidies for health savings accounts (HSAs) to make health insurance more affordable for those who lack it. These provisions would do little or nothing for the millions of people now receiving tax credits for coverage through the ACA, who often pay little in taxes and receive little benefit from deductions and have little to save in HSAs.
- Other Republican plans offer fixed dollar tax credits to purchase insurance, which would be of more value to low-income Americans, but would likely fall far short of the cost of coverage now covered by the ACA.
- A Trump administration could do a great deal of damage to the ACA without even changing regulations or guidance. If a Trump administration simply stopped implementing or enforcing certain regulatory requirements, there might be little that could be done about it.
- A change in leadership in the agencies implementing the ACA will cause months of disruption, and appointment of leadership committed to destroying rather than implementing the ACA will likely cause a mass exodus of lower level employees, causing an implementation vacuum.
- A Trump administration could abandon the Obama Administration's effort to ramp up enrollment, as well as efforts to work with insurers to ensure continued ACA participation or with consumers to resolve enrollment issues.
- The Obama administration is currently involved in a number of lawsuits involving the ACA. A Trump administration might simply cease defending these lawsuits, effectively allowing the plaintiffs to triumph.