By Ray Birch
ATLANTA—Although the Trump Administration has vowed to eliminate the Affordable Care Act (ACA) and replace it with something better, one healthcare expert said there is little relief on the horizon to the rising costs and challenges to credit unions in providing affordable coverage to staff.
For smaller credit unions, the pressure is likely to become stronger, the analyst added. And for everyone, employers, insurance companies, the insured, underinsured and uninsured, the flux will continue.
“There is very little stability here,” said Annette Bechtold, SVP of regulatory affairs and reform initiatives at health benefits advisory firm One Digital. “The steady increase in the cost of medical care and treatment continues. As costs rise, premiums rise. Employers, like the credit unions, continue to look for ways to still provide coverage at an affordable rate.”
They are likely to continue looking, according to Bechtold.
“With the advent of an all-new Congress in January, all legislation had to start over,” she reminded. “What’s universally known and understood is that costs are high and continuing to rise. They are becoming unsustainable for employers and employees. The big challenge is there is no consensus on how to fix it, even within a particular political party.”
Lack of Agreement
Bechtold said Democrats want universal coverage, but they can’t agree on what that looks like.
“Some want to further expand the Affordable Care Act in ways to foster near 100% participation,” she said. “Others want a public option, a health plan option run by the state to compete against the private market, while others feel that allowing individuals to buy into the existing Medicare plan might do the trick.”
There is also the Medicare for All bill introduced in the House and the Senate that would eliminate employer-sponsored coverage and replace it with a government-run program.
“Committee hearings are currently taking place on the Medicare for All bill. The biggest question mark is funding for this type market overhaul,” said Bechtold. “While the Congressional Budget Office has yet to score the bill, an independent firm finds it will amount to a $32-trillion price tag, or roughly $24,000 per household, assuming all households will pay equally, which would not be the case since this program will have to allow for those who don’t pay taxes or who are eligible for subsidies.”
Back in Court
Bechtold added that amid the legislative battles to “fix” the healthcare system are court battles over the ACA and other regulations stemming from President Trump’s 2017 executive order.
“Democrats, with House support, are gearing up to appeal the Texas District Court’s ruling that the entire ACA is unconstitutional, while the Republican coalition, backed by the White House, continue to challenge the law’s validity,” she said.
The Department of Labor is appealing a different district court judge’s decision that portions of the new Association Health Plan (AHP) rule, the outcome of the President’s executive order, violate ERISA and are not valid, Bechtold explained. “There is also another lawsuit challenging the DOL’s expansion of the short-term limited duration policies resulting from the executive order,” she said. “There is also word that the Department of Health and Human Services’ expansion of the state innovation waivers to modify certain ACA provisions may also see a legal challenge.”
Amid this turmoil some are trying to find ways to address the cost of prescription drugs, noted Bechtold.
“But this is a long-time problem requiring a long-term solution,” she added.
New Year a Lot Like Old Year
Overall, from the employer’s perspective, 2019 will look a lot like 2018, unless any proposed health insurance taxes are delayed or repealed, Bechtold said.
“We should see repeal bills pass in the House regarding the ‘Cadillac’ tax— a way to help fund benefits to the uninsured—and the tax on medical device manufacturers, and these may be able to pass the Senate. That might be a start to helping contain rates for 2020, but that’s not a certainty,” she said.
There are some emerging proposals offering solutions—such as direct primary care, value-based coverage, possible expansion of health savings accounts, and concierge services—which may be able to help manage the cost and position employers for a better future, explained Bechtold.
“But that’s dependent on the size of the group and the state in which they operate,” she said. “This will be an interesting year, to say the least, as the political parties gear up for next year’s presidential election. In that, healthcare reform will remain a topic of debate.”