Health Care Reform Revisited: 10 Years Later

The Affordable Care Act passed more than 10 years ago, but it’s still making headlines—especially because it's an election year. We remember digging into the ACA and sorting through all the details so we could advise our clients on what to tell people about health care reform. That was 2010. Since then, we’ve all experienced the ups and downs of implementing the ACA and anticipating whether or not the law might be dismantled under the current administration. 

So, where are things now? Let’s take a look at where we began and where we may be headed. 

A Look Back at the ACA

The ACA is the most comprehensive health care reform since Medicare and Medicaid were enacted in 1965. The ACA improved the accessibility, affordability, and quality of health care for millions of Americans—but we know there is still so much work to do, especially on the affordability side. 

Because this law affects so many Americans, it’s helpful to remember the history of the ACA and what the law means to Americans. The big things that have shifted the industry include: 

1. No matter your current health, you can’t be denied coverage (no more limits on pre-existing conditions).
2. Businesses with at least 50 full-time equivalent workers must offer affordable and minimum-value health plans or pay a penalty.
3. Health insurance exchanges must be set up in each state, where people can compare plan options based on price, benefits and services, and quality. And states have a choice on how to set up the exchanges. Or it may partner with the federal government. When states choose to opt out of the exchanges altogether, the federal government steps in and runs it for them.
4. To date, 39 states (including DC) have adopted the ACA’s Medicaid expansion. Total enrollment in Medicaid and CHIP grew to 73.5 million in May 2020. 

What Should Your People Expect in 2020?

Ten years later and the ACA is still being debated by both sides of the political aisle. Republican efforts to repeal and replace have failed, but a series of lawsuits have given us a lot to watch this year. 

Here are the big topics in the news:

What's Been Eliminated, What's Still Intact

Taxes and penalties, such as the excise tax on high-cost health plans (the Cadillac tax), the medical device excise tax, ACA’s health insurance tax, and the individual mandate, have been eliminated. Others, including the Patient-Centered Outcomes Research Institute (PCORI) fee and the Health Coverage Tax Credit (HCTC), remain intact. 

Also, the ACA still includes premium subsidies for Exchange coverage, Medicaid expansion, the employer mandate, protections for people with pre-existing conditions, coverage for children up to age 26, and medical loss ratio rules, to name a few.

A federal judge in Texas ruled in 2018 that the entire ACA was invalid because the individual mandate was eliminated. That decision is now on appeal to the U.S. Supreme Court, which will hold arguments on the case one week after the November 2020 election. The case has resulted in uncertainty about the future of the ACA. 

Medicare and Medicaid Changes 

Most health care reform debate centers around the individual market, the small group market, and Medicaid expansion under the ACA. 

Several states have requested the federal government to approve Medicaid work requirements, but ongoing litigation has put these efforts on hold. In addition, in three states (Missouri, Oklahoma, and Nebraska), voters approved ballot initiatives to adopt the ACA’s Medicaid expansion, but these initiatives have not yet been implemented.

What to Communicate to Your People

So, with all the uncertainty surrounding the ACA in 2020—on top of a pandemic, an election year, and all the complexity around our health care system—your people are likely confused and concerned about their health benefits. Even if you don’t have all the answers, communicating more during times of uncertainty builds trust. 

Our article in 2013 outlined key topics to address with your people, and the issue of health exchanges was among them. It is a useful reference for some of the larger points that you’ve probably already introduced to your people. 

Our rules of thumb still apply for communicating in the current environment, but there’s no need to try to educate your people about all the things you understand as an expert. Focus on what impacts them now and where they can take action. 

This is the time to reinforce that you have their best interests in mind and have a solid strategy in place. The questions they’re likely to ask will be about coverage and costs right now: Will our plans stay, or will they change? Will costs go up, or down?

Here are several messages to consider relaying:

• Your health and well-being are important to us. Remind everyone why you offer benefits and about the commitment you’re making to help them have healthier, more financially secure futures. Consider getting your leaders involved to emphasize the importance of keeping your people and their families healthy and safe. Well-being is top of mind for everyone, and you can’t over-communicate the ways your programs support the various aspects of well-being. 
• We have a thoughtful approach. Like many things, when it comes to health care, the only constant is change. It can help to explain the care and expertise that goes into making health care decisions at your organization. For example, as you do every year, you’ll assess your plans and premiums to ensure you’re providing comprehensive coverage options that meet the needs of your people, the business, and legislative requirements. Also talk about the ways you’re working to manage costs and provide value. Not everyone will be interested in this level of depth, but for those who are, it can be very helpful. 
• You can get a lot of value by using our benefits and taking steps to improve your health. As we said originally about the ACA, reminding people about what is within their control is really beneficial. And you have a lot of programs and tools that can help—with wellness goals, health management, and costs. Be sure to emphasize your programs that help people get the care they need and feel less intimidated by the system, such as advocacy and concierge programs.
• If you have questions, here’s where to go. Be sure all your communications offer contact information for HR, your call center, or wherever you field questions.

If you’re in the health care industry, you may need to provide additional information—typically from your leadership—about how they anticipate future changes in health care will affect your company. This communication could take the form of a message from your CEO, talking points, or an FAQ.

Health care is an intimidating topic for most people. Be thoughtful about what matters most to your people now and where they can take action.