What to Expect After 2016

The Affordable Care Act is in full effect, but will these mandates remain in place after the 2016 elections? Henry Aaron, senior fellow at Washington-based Brookings Institution with a PhD in health care-focused economics, outlines two scenarios for the New England Journal of Medicine.

If Republicans win the presidency and gain traction in Congress, a full repeal of the ACA is unlikely as popular parts of the law – insurance market reforms, subsidies for public exchange enrollment, and incentives for employers to provide affordable coverage – will have been in effect for several years. Additionally, repeal could hurt providers. What is more likely to occur is a scaling back of ACA – with cuts in affordability subsidies and a weakening of the penalties for people who remain uninsured. We could see a cap to Medicare spending, regardless of cost increases. A Republican Congress may also allow each state to curtail or reject certain ACA elements.

If the Democrats retain power, look for ACA changes to be more technical – with the first likely change being the calculation of what constitutes “affordable” employer-sponsored coverage. Currently, coverage is deemed affordable if worker premiums are less than 9.5% of household income, even for workers with dependents whose premiums are higher.

No matter the post-election scenario, expect the ACA to remain in place, with varying adjustments depending on the party in power.