Affordable Care Act (ACA) constantly changing & revised

By Dana Beezley-Smith, Ph.D.
March 9, 2016

Heathcare, psychologists and ACAPsychologists can be forgiven if they’ve lost track of changes to the Affordable Care Act (ACA): At its sixth anniversary, the statute has seen all three branches of the federal government undertake steps to alter it. The ACA has suffered three Supreme Court rewrites and 43 revisions through unilateral executive action. Twenty-four legislative modifications included the repeal of four programs and denied funding for seven others.

In late-2015 alone, a flurry of changes caused Zack Pace, senior vice president of benefits consulting at CBIZ, to say it was “like I was drinking from a six-inch fire hose.”

Congress passed the Consolidated Appropriations Act, 2016 (CAA) on Dec.18, in part to protect Americans from unpopular components of the ACA. However, since the targeted provisions have already become entrenched in the health sector, the bipartisan effort may not benefit consumers as was advertised.

Congress aimed to relieve some of the pressure of the looming 40 percent “Cadillac” tax on employer-sponsored insurance (ESI) in two ways: by delaying implementation two years and by allowing it to be tax-deductible as a business expense. Employers had begun readying for the tax long ago, though, trimming the value of insurance policies and increasing worker cost-sharing.

Will the tax delay inspire employers to temporarily restore plan generosity? Dayton, Ohio, benefits specialist Henry Stern doesn’t think so. “I’m not seeing plans getting beefed back up.”

Health policy expert Timothy Jost believes the answer depends on the perceived future of the Cadillac tax itself. If delay is viewed as a signal of the tax’s eventual repeal, it “may in fact have an effect on employee benefits going forward.”

Similarly, it’s unknown how carriers will react to the CAA’s 2017 moratorium on the health insurance tax (HIT) or “premium tax.” Initially assessed against insurers in 2014, the tax has applied upward pressure on premiums, primarily for individuals and small employers.

Consulting firm Oliver Wyman estimated last December that the one-year suspension could reduce 2017 premiums by over $200 per month “across all major fully funded insurance plans.”

Again Stern is skeptical about consumer relief. The HIT moratorium can’t reduce premiums, he maintains. “Look at all the (insurer) losses already booked. Nothing is going to staunch that kind of flow.” Premiums, he says, are “like the price of sugar or coffee: they go up, never down.”

Jost also notes that insurance companies could simply pocket the savings, absent “regulators or competitive conditions” compelling them to lower 2017 rates.

Also a financial burden borne by consumers, a 2.3 percent tax on medical devices was granted a temporary reprieve from enforcement in 2016 and 2017. Legislators in both parties believe the tax, which was implemented in 2013, is stifling innovation, slowing hiring and driving up patient expenses. As the tax has largely been built into current device prices, it’s questionable that manufacturers will temporarily lower them.

Finally, the spending package repealed 2016 funding for the highly controversial Independent Payment Advisory Board (IPAB), a 15-member administrative panel designed to cut Medicare reimbursements. The move was largely symbolic, given that IPAB won’t launch until federal outlays exceed an inflation-based target. In large part because of the Great Recession, the rate of increase in Medicare spending has slowed, and thus there is little chance the group will convene this year.

Depending on the outcome of the 2016 presidential election, psychologists may see changes much more dramatic than these. All but one contender propose to repeal the ACA and replace it with a new health care program.

Hillary Clinton vows to retain and improve upon the ACA by reducing drug and other consumer costs, while “building on delivery system reforms in the Affordable Care Act.” At a recent campaign event, she claimed that “it was called Hillarycare before it was called Obamacare, adding that “I don’t want to rip up this accomplishment.”

In contrast, both U.S. Sen. Bernie Sanders, who describes himself as a democratic socialist, and GOP businessman Donald Trump promise to replace the ACA with a universal coverage plan. Sanders envisions a “Medicare for all” program to replace ESI, individual policies, Medicaid/ CHIP and Tricare. While Trump hasn’t released specifics, he says “the government’s gonna pay for” his proposal. “We’ll work something out.”

Trump’s previous support for government-run health care in other countries has caused most – including columnist Philip Klein of The Washington Examiner – to believe he supports socialized medicine.

If candidates Clinton and Trump are the eventual nominees, he writes, “Democratic voters will have rejected the candidate pushing single-payer health care and Republicans will have embraced him.”


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Dana Beezley-Smith, Ph.D., is a clinical psychologist in private practice treating children, adults and families in Green, Ohio. She may be reached at

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