For his part, Trump has said that he favors keeping one key aspect, which outlawed the old practice by many insurers of refusing to cover people with preexisting medical problems or charging them more than other customers. The insurance industry has long said it would have a hard time abiding by this rule unless virtually all Americans are required to have insurance — a central feature of the ACA that Trump wants to cut.
This is the grand bargain underpinning the Affordable Care Act reforms of the individual health insurance market designed to save the market as it circled the adverse selection death spiral drain pre-2014.
It’s noteworthy Trump indicated during the presidential campaign that he wants to retain the prohibition on medical underwriting — the part of the deal imposed on health plan issuers in exchange for effectively forcing more people into the individual risk pool with the coverage mandate to help restore it to functioning. Keeping this ACA reform component in place suggests there will be no wholesale, rapid repeal of the health care law’s individual market reforms. Trump will clearly have to negotiate with health plan issuers if he wants to keep the medical underwriting ban intact, particularly if he wants to dispense with quid pro quo of the individual coverage mandate.
This demonstrates that the health care policy of the incoming Trump administration is a very rough work in progress that’s hardly set in stone. There will likely be a period of intense negotiations involving various stakeholders leading up to the new president’s inauguration and in the initial months of Trump’s administration.
The president-elect reaffirmed his position, The New York Times reported:
Mr. Trump said Friday that, after talking with President Obama this week, he might be willing to leave in place parts of the Affordable Care Act once he’s in office. Mr. Trump made the comments to The Wall Street Journal in his first interview since winning the election. The newspaper said Mr. Obama had urged the president-elect to reconsider repealing his signature health care law, which Mr. Trump said had become “unworkable.” But in the interview, Mr. Trump said he told the president that he would consider keeping two provisions of the law: the prohibition against insurers denying coverage because of a patient’s pre-existing condition; and the one that allows parents to keep their children on their insurance plans until they turn 26.
Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email