Have you heard the one about the president who wanted to undo the largest federal overhaul of the U.S. healthcare system in over half a century?
If the Affordable Care Act were a joke told among HR practitioners, it'd be as painfully overdone as a joke about airline food. For the past eight years, HR departments navigated the consequences of the individual and employer mandates, helped to support newly created healthcare exchanges and dealt with the ramifications of the Cadillac Tax.
Now, after a changing of the guard on Pennsylvania Avenue, those in charge of compliance are tasked to prepare for a storm with an uncertain forecast.
Should we stay or should we go?
President Donald Trump arrived on the political scene two years ago campaigning on a bevy of promises. Among his more orthodoxically conservative goals was his repeated call to "repeal and replace" the ACA.
It proved popular enough to unite GOP members in Congress with Trump's platform, and most Trump voters seemed to agree; one post-election Politico/Harvard poll revealed 85% of Trump voter respondents agreed that the ACA should be repealed immediately.
But in recent weeks, the lack of a definitive ACA repeal in the first 100 days has given compliance officers and media outlets an incredible amount of confusion. Some even reported that voters previously entrenched against the law began to shift their views in the polls.
Observers who spoke with HR Dive don't expect a blanket repeal of the law in the near future. Shan Fowler, Senior Director of Product Strategy of Benefitfocus, said that his firm's clients are advised to continue meeting current reporting requirements under the assumption that they won't be altered.
Judging by what's been proposed by GOP policymakers in Congress so far, however, Fowler isn't sure about the long-term future of the law, even if early drafts of proposed bills do seem employer friendly.
"That's the good news," Fowler said, "I think any short-term changes would be in employers' favor so to speak, in terms of removing potential penalties and administrative tasks."
Kim Buckey, VP of Client Services at DirectPath and a member of a team that worked with Trump's transition team, said the new administration seems to be "backing away from repeal and replace" in favor of "repair."
"In the short term, we're not going to see a whole lot change with respect to compliance," Buckey said. "I would just emphasize that the law is the law until it isn't."
Consumerism picks up the slack
HR professionals, don't mistake inactivity in Washington for stagnation in the healthcare solutions space. Trends like telemedicine and outcome-based care plans will continue to grow, while enrollment periods probably will not feel too much of an impact.
"The irony of the ACA was to bring a more consumer-centric approach to healthcare," Fowler said. The industry attempted to help smooth what had been a rocky transition in several ways, including the growth of private insurance exchanges. Though private exchanges didn't solve core problems outright, Fowler said the technological advances that made them possible helped to drive a consumerist approach.
"Our government is going to be somewhat behind the curve technologically, but encouraging consumerism would benefit everyone," Fowler said.
If you have major pain points, this is the time as an employer to have your voice heard.
VP of Client Services, DirectPath
Another aspect of this market-driven trend is low-cost plan adoption, particularly that of health savings accounts (HSAs) and high-deductible health plans (HDHPs). Buckey cautions employers about the effects of this trend, however, noting that employees aren't always savvy when it comes to choosing plans.
"We never taught people to be healthcare consumers," Buckey said. "We never teach people to shop around for healthcare services."
Increasing transparency and encouraging employees to be advocates for their healthcare will be essential to correcting this problem. Buckey anticipates that employers will increase benefits education and enrollment support as the issue moves forward.
Fewer employees are opting for HDHPs during the 2017 cycle. That's a warning sign to HR and healthcare advocates that no single plan solution will be the final one.
The bottom line
The ultimate fate of the ACA is, at this time, anything but decided. Fowler views the GOP's Cassidy-Collins proposal, which would essentially give states the option to retain the ACA as is (albeit with reduced federal funding), as having "softer language" than the president's executive order.
In the long view, assuming a full repeal does come to fruition, Fowler estimates that 18 million individuals could lose their health insurance without a replacement plan in place, although policymakers have called for a transition period in that event.
"We're at the lowest rate of uninsured in American history," Fowler said. "It's not a political statement: It's one that there will be a negative impact."
And regardless of the ACA's future, Buckey said there's a clear sense that cabinet members and administrative officials are more sensitive to business concerns given their background.
"If you have major pain points, this is the time as an employer to have your voice heard," Buckey said.