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Perspective: Technology Bombards and Trump Cards — What Payers Have and What They Need to React to "ACA Repeal and Replace"

Perspective: Technology Bombards and Trump Cards — What Payers Have and What They Need to React to "ACA Repeal and Replace"

This IDC Health Insights Perspective reflects the observations made by IDC Health Insights analysts regarding the evolution and potential change of the Affordable Care Act (ACA). Proposed alterations to ACA have been documented by President-Elect Donald Trump, and IDC hypothesizes that this would enable 5 new concepts and potentially affect 10 existing ACA features.The Affordable Care Act is multifaceted. IDC, as technology analysts, cannot opine about macroeconomics nor governmental approaches to taxes, subsidies, guaranteed issue, forced employer or consumer participation, and premiums. However, IDC can, inside-out from a payer perspective, foresee changes for exchanges/marketplaces, rating, consumerism, product mix, and how individuals might alternatively pay for insurance and healthcare. As IDC sees those trends, we can propose the technical effect of the election on front-, middle-, and back-office functions inside a payer.Nimble technology from hundreds of vendors was put in place since 2011. In 2018, governmental mandate will again heavily influence payer budgets. It may be a slow 2017 for technology purchases as things flush out, but as the "repeal and replace ACA" details are worked out, 2018 will continue the bombardment of technology, Trump cards and all.

Please Note: Extended description available upon request.

In This Perspective
Situation Overview
Legislative History
Upcoming Scheduled ACA Changes (or Not!)
Trump Card: ACA Additions and Changes to Consider
IDC's Point of View: Functional Analysis
Category A: Existing ACA Provisions Subject to the New Funding Model That Must Be Proposed
Balancing the Cost of the Program: Individualized Mandates and Subsidies
Technical Impact
Category B: Existing ACA Provisions That Are in Play Today, Potentially Altered with the Dawn of a New Administration
Contraceptive Mandate/Minimum Essential Benefits
Technical Impact
Age Banding
Technical Impact
Grandmothered Products
Technical Impact
Grandfathered Products
Technical Impact
Cadillac Tax
Technical Impact
3Rs: Reinsurance, Risk Adjustment, and Risk Corridors
Risk Adjustment
Risk Corridor
Category C: Change Likely as This Was Explicit in the Trump Platform
Allow the Sale of Insurance Across State Lines
Technical Impact
Tax Deductible Premium
Technical Impact
Health Savings Accounts
Technical Impact
Provider Price Transparency
Technical Impact
Importation of "Safe and Dependable" Drugs from Overseas
Technical Impact
IDC's Point of View: Vendor List
Essential Guidance
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