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12.16.2016 “On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare,” pledged President-elect Donald Trump during his campaign. But President-elect Trump is not the only one pushing for major reform. Other political leaders have also voiced their commitment to repealing the Affordable Care Act (ACA) – commonly referred to as ObamaCare. House Speaker Paul Ryan has been a fierce critic of the ACA and Senate Majority Leader Mitch McConnell went on record to say that the ACA was “…the single worst piece of legislation among many bad pieces of legislation passed…” and further stated that repealing the ACA was a “…high item on our agenda.” With 20 million Americans and counting currently covered by health insurance through the ACA, many are asking, what will happen to ObamaCare and our ability to get coverage? If the new administration sticks to its campaign pledge, you may likely see sweeping reforms if not an outright repeal and replacement of the ACA. Nevertheless, on the day Trump’s victory was announced, more than 100,000 people signed up for Obamacare, setting a record number. While the precise future of the ACA remains uncertain, statements from President-elect Trump, current alternative proposals to ObamaCare, and Trump’s newly appointed health secretary – Representative Tom Price – shed some potential light on what may be in store. 1. The Affordable Care Act could change significantly

Aside from pledging on day one of the campaign to repeal and replace the ACA, Trump recently appointed a longtime critic of the ACA, Representative Tom Price, as the Secretary of Health and Human Services. Price himself has spent years putting together a comprehensive alternative plan to the ACA – the Empowering Patients First Act – and was hailed by Trump as being “…exceptionally qualified to shepherd our commitment to repeal and replace Obamacare…” The exact changes remain to be seen, but key aspects of Price’s alternative plan may serve as a basis for ACA reform.

2. Popular aspects of the ACA may remain

Trump recently stated in a televised interview on CBS that popular aspects of the ACA should remain, particularly the pre-existing conditions clause and the ability for young adults to remain insured through their parent’s policies. However, Price’s proposed plan creates significant deviations from the original intention of the pre-existing conditions clause. In Price’s plan, the pre-existing conditions clause – dubbed the “continuous coverage clause” – would prevent insurance companies from denying coverage to patients so long as they had continuous coverage for the 18 months prior to choosing a new policy.

3. The ACA reform could feature fixed tax credits and increased use of health savings accounts

Price’s Empowering Patients First Act advocates for a flat tax credit of $1,200 a year (which would rise with age) for people to purchase insurance on the private market. Price’s plan further pushes for the increased use of health savings accounts to encourage more people to put non-taxable income into an account that is dedicated to paying for health care costs.

4. The government mandate to have coverage may potentially be history

If key components of Price’s health plan come into effect, the current government mandate requiring all people to get coverage could be gone. Thus, there would be no government tax or penalty for not possessing or obtaining health insurance.

5. High-risk pools could be created to help people with existing conditions get affordable health insurance on the private market

For those people that face higher insurance premiums due to chronic illness or having pre-existing conditions, Price’s plan proposes the creation of high-risk pools. These pools would be funded by federal money to help people with existing medical conditions and who are not covered under an employer’s plan, better afford and get insurance through the private market.

6. Health care and Medicare may become more privatized

A major aspect of Trump’s statements and Price’s plan involves less government regulation of the health care system and encouraging more people to obtain health insurance through the private marketplace. The incoming administration has advocated for a more hands-free approach and to increase competition amongst insurance companies as one way to drive down insurance premiums and thereby create more affordable health care.

Though the ACA’s fate remains uncertain, the Chronic Disease Coalition urges policy makers to ensure that patients are held harmless as the deliberation of health care delivery models continue. No matter the circumstance, chronic disease patients should in no way, shape or form be subjected to any kind of discrimination. That is certain.