Repeal and Replace? Affordable Care Act and the Impending Avalanche of Change

by Lauren Fuller

The 2016 elections resulted in the selection of a Republican President and Congress, taking the reins of the federal government in 2017.  The President-elect Donald J. Trump repeatedly promised to repeal the Patient Protection and Affordable Care Act (“Affordable Care Act”) and the Republicans in Congress tried multiple times during the last six years to repeal the legislation.  Now the stage is set to fulfill those promises in 2017.  SAFPhIR will keep subscribers informed in real time of those changes at the federal level as well as the avalanche of state and regulatory changes that will follow.

Review a :15 second presentation about SAFPhIR HERE.   Or, request a demo HERE to see first hand how SAFPhIR’s platform helps your operations navigate these changes and make smarter business decisions.

The 2000-page law is replete with provisions that affect managed care and pharmaceutical manufacturers.  A sampling of those issues include the following:  prohibition on lifetime annual insurance limits; extension of dependent coverage; changes to the appeals process; prohibition on pre-existing condition insurance exclusions; guaranteed insurance coverage and renewability; essential health benefit requirements; refundable tax credits; state Medicaid expansions; prescription drug rebates; hospital value-based  purchase programs; quality ratings; Medicare Advantage payment changes; a Medicare coverage gap program; formulary requirements for prescription drug plans and Medicare Advantage prescription drug plans; Medicare annual wellness visits; comparative effectiveness research requirements; creation of a new biosimilars pathway of approval; and significant taxes (“annual fees”) on pharmaceutical manufacturers, medical device manufacturers and health insurance providers.

The question is whether the law passed in 2010 will be completely repealed and replaced or simply modified and reshaped.  Due to its unpopularity and increasing costs, there is virtually no question that there will be a flurry of activity on the Affordable Care Act next year.  The activity will be at both the state and federal levels and SAFPhIR is the essential tool to keeping track of the myriad of laws that will result.

Also, the President-elect promised to halt the increasing number of regulations.  SAFPhIR will provide immeasurable information to keep subscribers abreast of regulatory changes.

States, in reacting to the changes in the federal law, will undoubtedly be faced with addressing changes in their legislatures which will affect business operations of the managed care and pharmaceutical industries.  Even the state Boards of Pharmacy will likely be faced with changes and SAFPhIR is the one-stop shop for these releases, too.

Anyone who followed the congressional efforts in five committees of the House and Senate in 2009-2010 will recall the difficulties of following five bills and sorting through the final enactments.  SAFPhIR will continue to provide summaries and expert analysis with links to the final laws that affect managed care and pharmaceutical industries.

Some of the proposals raised during the presidential campaign include promoting tax-free health savings accounts and allowing people to deduct the cost of premiums on their personal income tax returns.  Also, the idea of allowing insurers to sell policies across state lines to boost competition was discussed.  Various methods of effectuating changes to the Affordable Care Act were raised but the President could simply suspend the regulations or refuse to fund the regulatory requirements through the budget process.  Whatever the approach, SAFPhIR will be your guide to deciphering the changes.

Don’t find yourself in the avalanche of new health care laws without SAFPhIR.