Summary
In light of the Republican control of the White House and Congress next year, we believe it is likely they will pursue budget reconciliation to repeal key components of the Affordable Care Act and replace them with new or differentiated policies that meet similar goals. President-elect Trump and key congressional leaders have already reiterated that this is among their top priorities, perhaps their highest.
Therefore, we have prepared the attached memorandum to outline what we anticipate will be the most likely policies to be considered for such a package, drawing from the key clues Republicans have disseminated recently. Most notably, these include the vetoed 2015 ACA repeal reconciliation bill and House Speaker Paul Ryan and other congressional Republican leaders’ replacement plan announced in June of this year. Other related proposals are also included for additional color.
Further, we include in the memo a description of the rules and processes of budget reconciliation, which is a critical consideration for determining what can get enacted next year. Many policies in the ACA, most notably the commercial insurance market reforms and patient protections, cannot be addressed via reconciliation.
Thus the crux of the question Republicans face is how they will repeal or reduce the ACA’s coverage expansions, including enhanced Medicaid matching funds, individual premium tax credit subsidies, and the individual mandate, while leaving the consumer protections and other insurance regulations in place. This question is now much more acute in light of the fact that what Republicans produce is likely to become the law of the land.
So, while we cannot foresee the final outcome of what will undoubtedly be an extremely robust and contentious effort, we hope this memorandum is a first step toward helping you and your organization understand the potential policies that will be addressed in this environment.