What are the most realistic changes that Donald Trump will be able to make to ACA? originally appeared on Quora - the knowledge sharing network where compelling questions are answered by people with unique insights.
Answer by Jennifer Fitzgerald, CEO and Co-Founder of PolicyGenius, on Quora.
Trump has the support of Republicans to repeal and replace the ACA, and it seems to be at the top of his list. Take Tom Price, Trump's pick to head HHS: he authored a 2015 bill to defund Obamacare. Realistically, Trump can make a lot of changes to the program.
What those changes will be remains to be seen, but we have some ideas of what he wants to implement. First, Trump has claimed that he'd get rid of the individual mandate penalty. That's one of the main tenets of the ACA, strengthening the risk pool to support people who use their health insurance more often and are more expensive to insure.
Trump has also voiced support for getting rid of tax subsidies that several million Americans use to help lower the cost of monthly premiums. The subsidies would likely be replaced by the ability to fully deduct health insurance premiums from your taxes.
Trump also wants to expand the availability of health savings accounts (HSAs) and what can be done with them (like making them inheritable by heirs).
Some things are still unknown, like whether or not the ten essential benefits will still be covered by all health plans or if discrimination by pre-existing conditions or gender will be allowed again. Many see these as consumer protections as some of the most positive aspects of the ACA, while others think that they inflate the price of policies (for example - every plan must cover procedures associated with pregnancy, even if the policyholder won't ever use that benefit).
None of these changes are out of the realm of possibility for Trump, especially with a Republican-controlled legislative branch supporting him. As mentioned, Tom Price has already made moves to get rid of Obamacare, as has Paul Ryan with his Better Way plan. It's not so much a question of "if" as much as it is "when" it will happen, and what exactly will take the ACA's place.
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