What the election results mean for employer health plans

Donald Trump has won his race for a second term as president, Republicans will have control over the U.S. Senate and, at press time, Republicans appeared to have a chance to retain control over the House.

What could that mean for employer-sponsored health and welfare plans and the employers’ benefits brokers, consultants and advisors?

Related: Trump-Harris debate: Takeaways on ACA, private health insurance

The shift is likely to affect everything from postage stamps to the White House website, but here are five areas where it could make the biggest difference.

1. The Affordable Care Act: The administration of President Joe Biden has been an enthusiastic supporter of the ACA public exchange system and premium tax credit subsidies.

Trump supported ACA repeal efforts during his first term but complied with the laws and regulations that were in effect. Residents of two Republican-led states, Texas and Florida, are heavy users of ACA exchange plans purchased through HealthCare.gov.

Idaho, a Republican-led state, has a popular state-run ACA public exchange program.

Trump could move to cripple the ACA exchange system immediately. He could also compromise by ending efforts to expand the ACA exchange system or keep the extra premium tax credits provided in response to the COVID-19 pandemic in place but also pulling back from active efforts to kill the exchange plan system altogether.

Any Republican moves to let the ACA exchange plan system live could help the benefit plan administrators trying to set up individual coverage health reimbursement arrangement programs, or ICHRA programs. Workers with ICHRAs can use employer cash to buy their own individual health coverage on a guaranteed-issue basis without facing underwriting based on health status.

2. Potential group major medical alternatives: The Biden administration has tried to protect the ACA framework for the group health insurance system against “antiselection pressure,” or the risk that low-risk employers will avoid using fully insured health insurance and cause the average risk level of the employers still in the fully insured market to soar.

Some of the efforts to defend the fully insured group market have included regulations that restrict how arrangements like short-term health insurance, hospital indemnity insurance and multi-state association health plans.

The administration has also been hostile to use of stop-loss insurance policies, or insurance policies for self-insured employer health plans, with low “attachment points,” to stop-loss deductibles.

Self-insured health plans operate under the Employee Retirement Income Security Act, a 1974 law that seeks to lower administrative costs for large employer plans by letting the plans comply with federal standards, rather than having to comply with standards in all 50 states.

Critics of low-deductible stop-loss coverage have argued that it’s a tool low-risk small employers use to escape from the fully insured small-group market. That increases antiselection pressure against issuers of fully insured small-group insurance and kills the small-group market, the critics contend.

Some large health insurers have backed federal efforts to crack down on potential rivals to fully insured group health insurance.

But many Republican candidates have criticized health insurers, and the Trump administration seems likely to end efforts to restrict the major medical insurance alternatives.

3. Pharmaceutical makers and pharmacy benefit managers: The Biden administration has emphasized efforts to cap out-of-pocket spending on prescription drugs for Medicare plan enrollees and back Medicare program price negotiations with drug makers.

Trump could continue with a modified version of drug price negotiation effort, because he supported the concept of drug price negotiations during his first time.

Many Democrats and Republicans in the new Congress have received support from independent pharmacy groups that want to keep pharmacy benefit managers from limiting participation in the PBMs’ pharmacy networks or pushing patients get drugs from the PBMs’ own mail-order pharmacies..

Efforts to pass new PBM legislation may be one area in which Democrats and Republicans in the House and Senate find ways to work together.

4. Health accounts: The Biden administration and key Democrats in Congress have not made much effort to support or restrict health savings accounts, health reimbursement arrangements or flexible spending arrangements in recent years.

The most liberal Democrats in Washington have tended to be hostile toward health account programs, seeing them mainly as a tax shelter for high-income people. Republicans tend to be enthusiastic supporters of health accounts.

The new election results could lead to the consideration of many new health account program expansion and creation programs and the adoption of a few.

5. Long-term care: Trump is 78 and may be old enough to know many people who are using or thinking about using long-term care services.

A hospital in Queens once had a nursing care and rehabilitation pavilion named after his mother.

During his campaign, he presented proposals for boosting support for in-home for older people and adding a tax credit for family caregivers.

Republican congressional candidates have also talked about ideas for improving support for caregivers and expanding access to long-term care services.

Work on new tax breaks and programs related to long-term care needs could continue over the next four years. Any tax breaks or programs actually implemented might create opportunities for developers of private long-term care benefits options.