Is the ACA Really Dead?

One year into Donald Trump’s presidency, most would agree that his biggest legislative victory is the recently-passed tax reform legislation. Tax reform was a top priority for the new president, and the bill’s passage helps President Trump fulfill an important campaign promise. Two promises actually:

1. While running for office, candidate Trump promised to cut taxes, and though many worry that the new tax law benefits corporations and the wealthy much more than it benefits the middle class, the bill does provide at least temporary tax relief to a majority of Americans.
2. Embedded in the tax bill, though, was a repeal of the unpopular individual mandate. As a candidate, President Trump had promised to get rid of the mandate, and the bill he signed into law on Friday, December 22 makes good on that promise.

To hear President Trump tell it, though, the new law not only repeals the individual mandate but actually kills the ACA altogether. In a speech praising the legislation, President Trump claimed that “We essentially repealed Obamacare.” Not everyone agrees. As The Washington Post points out, while the law does repeal one of the major components of the Affordable Care Act, “experts say that does not mean Obamacare is dead. It is just in trouble.”

Of course, this isn’t the first time President Trump has talked about the ACA’s demise. Here’s a tweet from this summer, before any provisions had been repealed, claiming that Obamacare is dead:

I suggest that we add more dollars to Healthcare and make it the best anywhere. ObamaCare is dead - the Republicans will do much better!

— Donald J. Trump (@realDonaldTrump) May 28, 2017

So is President Trump correct? Does a repeal of the individual mandate essentially kill the Affordable Care Act? That doesn’t appear to be the case. Preliminary reports from CMS say that the 2018 enrollment period, which ended December 15, was actually a success. In the end, more than 8.8 million people enrolled or re-enrolled in individual coverage through Healthcare.gov. According to the Washington Post, that’s only down slightly from last year’s number of 9.2 million.

When we consider that the 2018 open enrollment period was only half as long as last year—six weeks vs. three months—and that the ACA’s marketing budget was slashed, it’s hard to claim that open enrollment wasn’t a success. At the very least, the solid enrollment figures indicate that the ACA isn’t dead yet.

That said, the mandate’s repeal does create uncertainty for the next open enrollment period. Will carriers really continue to offer guaranteed-issue coverage if healthy people are not required to sign up? It’s probably too early to tell. Some say that this could be the straw that breaks the camel’s back and that carriers will exit the market when the mandate goes away in 2019. Others say that the mandate was never very strong and that fact is already reflected in the rates insurers are charging consumers.

For now, nothing is changing. The individual mandate is still in effect for 2018, and we should probably keep doing what we’ve been doing: taking the ACA one year at a time, realizing that the future is uncertain but that we must continue to provide our clients with the best guidance we can based on what we know right now. As we learn more about the impact of this latest development, we’ll be sure to let you know.