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November 09, 2016 at 10:19 AM
Insurance agents, brokers and others are starting to wrap their brains around an amazing reality: Barring a very unlikely Electoral College upheaval, a Republican administration will be in charge of administering the Affordable Care Act.
The fourth-annual ACA open enrollment period for 2017 started Nov. 1 and is set to end Jan. 31, 11 days after Donald Trump is to be sworn in as the next president of the United States of America.
Related: What a Trump presidency means for the ACA
Barack Obama had to work hard to get anything big passed during his first term in the White House, even though he started with personal experience as a senator, a Democratic majority in the House and what was regarded as a “filibuster-proof” Democratic majority in the Senate. The most liberal Democrats gave him almost as much grief as the Republicans.
Trump appears to be on track to enter the White House in what could be a weaker starting position. He has no personal experience with serving in the federal government, and he will start with only a narrow Republican majority in the Senate.
Related: 5 ways a Republican Congress could change health policy
To get ordinary legislation through the Senate, Trump will have to hold on to what are regarded as the most moderate Republican senators, Dean Heller of Nevada and Susan Collins of Maine, and at least seven of the Democratic senators who are at least as close to the neighborhood of the center as Sen. Charles Schumer (D-N.Y.), who is likely to be the next Senate minority leader. One of those moderately liberal senators Trump might need to court is Sen. Tim Kaine (D-Va.), Hillary Clinton’s running mate.
Kaine lost, but he helped his ticket win in Virginia, on a difficult night for Democrats, and that might give him some extra clout in the Senate.
Meanwhile, Trump knows about insurance and benefits issues mainly through his role as a business owner, and through his interaction with campaign advisors, such as Dr. Ben Carson, a former Johns Hopkins neurosurgeon.
Trump has said he wants to repeal the ACA and replace it with a combination of an expanded health savings account program and interstate insurance sales.
Here are some ideas about how that could hurt some health insurance industry players and help others over the next two years:
Likely losers
1. The term “Affordable Care Act.”
The incoming Trump administration may find actually killing ACA is time-consuming, or even impossible. Some major Republican ACA replacement plans have included many popular ACA provisions.
But the rapid growth of ACA jargon has confused even the friends of the ACA, and the new administration may be eager to rid itself of as much of that terminology as possible as quickly as possible.
2. The consultants and think tanks that shaped the ACA.
The ACA idea people might have been right about what they proposed. ACA defenders might say ACA World problems have had more to do with the rushed, secretive process Democrats used to get the ACA legislation through Congress, and with fierce Republican opposition to the law, than with the ideas inside the law.
But, in the end, the ACA legislation created a framework so complicated and market upheaval so severe that many Democrats, including Clinton and Kaine, avoided talking much about it on the campaign trail. The fourth open enrollment period became a topic to avoid, rather than a triumphant event to celebrate.
3. Bernie Sanders and other advocates of single-payer health care.
Some of Vermont Sen. Bernie Sanders’ allies say Clinton was simply too corrupt, and too friendly to big corporations, and that conspirators inside the Democratic Party apparatus kept him off the general election ballot. But his supporters did get a government-run health care system proposal on the ballot in Colorado, a state that often votes for Democrats. In a way, the measure could be considered a stand-in for Sanders himself.
Clinton scraped up a narrow victory in Colorado, and Sen. Michael Bennet, a Democrat, beat off a challenge by Republican Darryl Glenn.
But Bennet and other prominent Democrats in Colorado opposed the measure, and Colorado voters defeated it by a margin of 20.3 percent to 79.7 percent.
4. Single-state Blue Cross and Blue Shield gorillas.
Some of the remaining Blues are giant, nonprofit companies that cover half or more of the commercial health plan enrollees in their markets.
Efforts by Trump to allow interstate sales of health coverage could appeal to some Democrats. State insurance regulators contend that letting insurers choose their own home-state regulator could lead to insurers having no real choice but to flock to the weakest regulator.
Interstate health coverage sales could also benefit the big national carriers at the expense of carriers that have not had to face serious competition in years.
5. Nonprofit ACA exchange plan helper programs.
The Trump administration may see grants for state ACA exchange navigator programs and certified application counselor programs as love notes to Democratic-supported health policy organizations.
Possible winners
1. Trump’s own insurance and benefits advisors.
