Katy Spangler, a veteran federal health policy shaper, says health policy may be one of the first topics the next president of the United States has to address.

If the next president is Hillary Clinton, for example, “I don’t think she wants to spend her first 100 to 1,000 days in office working on health care,” Spangler said recently. “But I think she will probably be forced to, given what’s shaping up with the individual market and the [Affordable Care Act] questions.”

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Spangler talked about the health policymaking climate in Washington, and how it could change in 2017, during a web-based Sun Life Summit conference organized by the Wellesley Hills, Massachusetts-based U.S. arm of Sun Life Financial.

Spangler is now a health policy specialist in the Washington-based office of the American Benefits Council. She previously worked on health policy on the Republican staff of the Senate Health, Education, Labor and Pensions Committee.

Spangler said a new President Clinton would have to work with Republicans in the Senate as well as Democrats to pass an individual health market and ACA exchange rescue package.

“What would such a package look like?” Spangler asked.

Around 2020, an ACA provision that limits increases in tax credit spending to the overall inflation rate will kick in. ACA supporters’ need to adjust that limit “gives Republicans some leverage,” Spangler said.

For more about what Spangler said about what might come next, read on.

Spangler says the Cadillac plan tax fight shows how tough changing anything is in Washington these days. (Image: Doris Kindersley/Thinkstock)

Spangler says the Cadillac plan tax fight shows how tough changing anything is in Washington these days. (Image: Dorling Kindersley/Thinkstock) 

Spangler sees lingering pressure for employers to send workers to the individual market

In recent years, one of Spangler’s major areas of focus has been working to fight the “Cadillac plan tax”, or the 40 percent excise tax that the ACA seeks to impose what the government classifies as rich health benefits packages. Congress recently postponed the effective date of the Cadillac plan tax for two years, and it created a permanent provision letting employers deduct the excise tax as a business tax.

But the tax itself is still on the books, even though opponents persuaded 90 senators to vote for an amendment killing the tax, and have rounded up about 300 cosponsors for House measures that would kill the tax, Spangler said.

“It’s a tough environment out there,” Spangler said.

Because the environment is so tough, Clinton would be unlikely to be able to get any major proposal for a big, “public option” government health insurance plan through Congress, Spangler said.

Rather than trying to pass a public option program, a President Clinton might use “waiver programs” to let states create their own public option programs within the existing legal framework, she said.

But proposals to expand the health savings account program and let employers use health reimbursement arrangements to give workers cash they can use to pay for their own health coverage seem to have bipartisan support and could get through Congress, Spangler said.

Efforts to have employers send workers to the individual health insurance market also seem to continue to have support from both Democrats and Republicans, she said.

If Donald Trump becomes president, he may follow the lead of the Obama administration and use an aggressive approach to the regulatory process to deregulate the health insurance market as aggressively as possible, Spangler said. But she said procedural constraints would probably limit just how much he could do.

Spangler said she still has some hopes that Republicans will realize that the ACA is here to stay, that the Democrats will realize the law is fallible, and that members of both parties will work together to fix the problems in the law.

“Maybe 2017 will be the year,” Spangler said.

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