Straight Talk About The Affordable Care Act

February 21, 2017
Doctor performing an exam on a patient.
Michael Grossman

Michael Grossman, President

The Bank of San Antonio Insurance Group


Confusion about the current status of the Affordable Care Act (ACA) and the Repeal and Replace initiative seems to be getting worse by the day. I hope I can help clarify the situation by sharing what I learned by meeting with Legislators this week in Washington, DC. I’ll describe what lawmakers are actually saying about Healthcare Legislation versus what is represented in the news and social media.


The ACA will likely be repealed through the Reconciliation Process, which allows only budget-related portions of the law to be repealed. For instance: the individual mandate (fine) can be repealed. The portion of the law that allows dependent children to be covered to age 26 cannot be repealed, nor can the removal of pre-existing exclusions. Repealing the entire ACA is unlikely — eight Democrats would have to side with all Republicans. Even if this improbable scenario played out, the Representatives I visited with want to keep coverage of dependent children and pre-existing conditions regardless.


Insurance carriers are unsettled with the current situation and are pulling out of the Insurance Exchange. Premiums were already escalating at a dramatic pace and the Exchange was going to fail. To promote Market Stability (a term you will hear often this month) the administration is proposing rules (published 2/17) that address changes to the special enrollment periods, actuarial value requirements, and network adequacy, to name a few. This is at least a start in the right direction.


The White House has had discussions and Congress has had hearings with industry leaders in Pharmaceuticals, Insurance, and Medical Device Manufacturing. People are coming together with a common goal. Maybe I’m optimistic, but I see positive, quick-paced work being done that is not always covered in the news. My personal discussions with some of the Representatives included more context about making improvements versus complete Repeal-And-Replace. In fact, the term Repeal Plus was used quite often. This would improve the system, instead of completely overhauling it for a second time.


Initially, Congress announced that they would use a three-pronged process for health reform:

1. Repeal the law through a fast-track process by the end of March.

2. Pass a replacement plan.

3. Use the administration's regulatory authority to stabilize the health insurance market.

We have seen the administration issue proposed rules for stabilization already, and from my conversations, I believe we will see the current plan modified, instead of a completely different replacement plan.

This is taking shape quickly. In fact, as I write this we could see further modifications. I am optimistic and hopeful that whatever side of the aisle you favor, we soon will be seeing improvements for everyone.