One of the significant campaign promises Donald Trump made during the course of the 2016 presidential campaign was to “repeal and replace” the Affordable Care Act. During the early months, rumblings on Capitol Hill in Washington, D.C., occurred about repealing and replacing ACA. However, the ACA was not repealed. There were a number of changes made to the healthcare and health insurance law most often referred to by the public-at-large as Obamacare.
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Elimination of the Individual Mandate
Perhaps the most significant change made to the ACA under the Trump Administration is the elimination of what is known as the individual mandate. The individual mandate was the requirement under the ACA that people lacking health insurance coverage from their employers or some other source and people who didn’t qualify for Medicaid or Medicare needed to obtain coverage, usually through the ACA Exchanges. If people obliged to obtain health insurance in this manner failed to do so, they faced a penalty on their taxes. The Trump Administration took the teeth out of the individual mandate and lowered the tax penalty to $0, according to National Public Radio.
States Permitted to Add a Work Requirement to Medicaid
ACA permitted states to expand their Medicaid programs. Specifically, states could expand Medicaid to include all low-income adults. In addition, through the ACA Medicaid expansion, the income threshold was increased, increasing the number of people eligible for Medicaid via the ACA. 37 states and the District of Columbia expanded Medicaid as a result of the ACA.
The Trump Administration altered ACA in regard to expanded Medicaid. The Trump Administration altered the law to permit states the ability to require people eligible for expanded Medicaid to demonstrate that they are working or attending school.
Termination of ACA Cost-Sharing Subsidies
One of the features of the ACA was a cost-sharing scheme. The federal government provided insurance companies that participated in the ACA Exchanges payments to assist these insurers in keeping premiums costs lower and to entice them to continue to participate. In 2017, with no warning to insurance companies, the Trump Administration stopped making these payments.
Return of “Skinny” Insurance Plans
With the initial enactment of the ACA, health insurance policies had to have minimum levels of coverage. Pursuant to the ACA, short-term policies with less coverage could only be used to a consumer for three months.
The Trump Administration changed the availability of these “skinny” policies. A consumer can now have a skinny policy for 364 days. When that initial time period lapses, a consumer can renew a skinny policy for up to three more years.
The full repeal of the ACA proved impossible when Republicans controlled the White House and both Houses of Congress. When the GOP lost the House of Representatives in the 2018 election, no further meaningful discussion occurred on Capitol Hill regarding further changes to the ACA. Discussions and debate about further changes to ACA are not likely to occur until after the 2020 election. Moreover, the scope of such a post-2020 election will be governed significantly by which party controls the White House, the House of Representatives, and the Senate.