One of the most memorable achievements of the Obama administration is the Affordable Care Act (ACA). The bitter debates about this legislation that started long before its passage continue to this day—becoming a focal point of the 2016 presidential campaign. With the election still a few months away, it’s unclear exactly how healthcare and the ACA will be affected. What is clear, though, is that each candidate believes he or she has the right solution to fix America’s ailing healthcare system.
how benefits might change in 2017
Our Healthcare Services Chairman, Dennis Triplett, explores how each presidential candidate’s health care platform could impact employee benefits and businesses.

  • How we’re still feeling the Bern as Bernie Sanders continues to influence the Democratic health care conversation.
  • How might Hillary Clinton’s healthcare ideas play out?
  • Can Donald Trump repeal the ACA?
  • How might HSAs be affected?

Of course, we recognize that as with all things political, anything could change.

Still feeling the Bern

Will we still feel the Bern of free healthcare? Bernie Sanders may not have won the Democratic Party nomination, but he has shaped and influenced the party’s platform on several key issues—including health care.

For him, the ACA isn’t good enough because 29 million Americans are still uninsured. And many who are insured can’t afford their deductibles.

The Sanders’ plan would have expanded Medicare to all Americans.

This has the benefit of separating health insurance from employment, which gives employees the freedom to change jobs or start their own business without the worry of losing health insurance.

He also suggests that it also would be a benefit to employers who no longer have the need to administer benefits plans and can focus more time and resources on running their core businesses.
Bernie Sanders
Leave no one behind

  • Medicare for all.
  • Separate health insurance from employment.
    • Employees can change jobs without fear of losing health insurance.
  • Employers can focus on running their businesses—not administering benefit plans.


  • Coverage for all Americans.
  • Relieves employers of a huge expense.


  • No out-of-pocket maximums on Medicare, and other coverage gaps.
  • Benefits become less of an employment differentiator.

How might Hillary Clinton’s policy ideas play out?

Clinton believes her more progressive approach on health care could help her with her base in the matchup against Trump. Her primary focus is on making the ACA work, and following President Obama’s lead she’s pledged to defend it against GOP efforts to repeal it.

  • Stay the course and make incremental changes
  • Make premiums more affordable and lessen out-of-pocket expenses.
  • $5,000 tax credit for families with out-of-pocket costs over 5 percent of their income.
  • Enhance premium tax credits.
  • Block or modify unreasonable health insurance premium rate increases.
  • Support new incentives to encourage all states to expand Medicaid.
  • Expand Medicaid in every state.
  • Invest in navigators, advertising and other consumer outreach.
  • Expand access to ACA exchange to families, regardless of immigration status.
  • Continues to support a “public option” to reduce costs and broaden the coverage choices.
  • Establish a federally run public option
  • Allow people to enroll in Medicare earlier, at age 55
  • Increase federal funding for community based health centers by $40 billion over the next decade.
  • Proposed a package of additional reforms.
  • Lower out-of-pocket costs, such as co-pays and deductibles.
  • Reduce the cost of prescription drugs.
  • Reward value and quality.
  • Expand access to rural Americans.
  • Provide women access to reproductive health care.

Can Trump repeal the ACA?

As just about everyone knows, Trump has branded himself as both the anti-establishment and the anti-ACA candidate. If elected, he promises his first order of business will be to ask Congress to immediately deliver a full repeal of Obamacare.

“No person should be required to buy insurance unless he or she wants to.”—Donald Trump

Trump’s plan:

  • Replace ACA with free market reforms to the health care industry that will broaden access and improve affordability and the quality of care.
  • Allow the sale of health insurance across state lines.
  • Tax credit for families that don’t have employer coverage.
  • Make health insurance premium payments tax deductible.
  • Establish high-risk insurance pools.
  • Work with states to review Medicaid options.
  • Provide block grants to states.
  • Incentivize states to remove fraud and waste from the system.
  • Raise the Medicare eligibility age from 65 to 67.
  • Price transparency and consumer tools.
  • Consumers could shop for health care like they do other products.
  • Allow cross-border prescription drug purchases.
  • Health savings accounts for all.
  • Tax-free contributions.
  • Appealing to younger people.
  • Account balance can be used by any family member without penalty.
  • Inheritable without a penalty.

Trump will most likely let Congress take the lead on these proposed reforms since healthcare is not one of his key platform issues.

Trump promises that his administration would require price transparency from all health care providers, especially doctors and health care organizations like clinics and hospitals. Individuals would be able to shop for health care like they do other products so that they can find the best prices for procedures, exams or any other medical-related service. On a related note, the lack of price transparency has been one of the biggest challenges for people with HSAs.

Future of ACA

Unlikely to be replaced because of political obstacles and devastating effect on covered individuals but…

Despite the pre-election banter, my view is that it’s unlikely that the ACA will be going away any time soon.

As you’ve heard, the political obstacles associated with repeal are tremendous.

While I think full or total repeal is unlikely, change is inevitable regardless of whom our next President will be. So following the election, I think I would characterize the degree of probable change as mild to wild. Mild if we have a Democrat in the oval office to wild if we have a Republican. And that change will likely come in the President’s first 12-18 months in office as he or she puts their election mandate to the test. Change will be tempered by the Senatorial elections and we should keep our eyes on those races.  The House will likely remain in the Republican camp and the Speaker Ryan will have an influential role in how healthcare is reshaped in our country.


The content above represents the author’s personal views and not those of UMB Bank or UMB Financial.


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