When holding a conference during an election year, the topic of politics is nearly impossible to avoid. A presentation in late September at EBN’s Benefits Forum and Expo in Nashville, Tenn., centered on the role the new president will have on the world of employee benefits and healthcare. Roger Abramson, general counsel for Ameriflex, and Kevin McKechnie, executive director, HSA counsel of the American Bankers Association, discussed the top benefit priorities of the new president after he or she is sworn in on Jan. 20, 2017.
EBN: What impact will the election have on the benefit space?
Roger Abramson: There will be a lot of tinkering on the ACA. Republicans have wanted to work on it for a long time. Democrats didn’t want to mess with President Obama’s legacy. Once he is out of office, they know there is a public hunger to do some tinkering in that regard. … The Cadillac tax will be the first one. The interesting thing about the Cadillac Tax is you have people on both sides of the aisle who want that gone. You do have people on the Republican side who don’t want the Cadillac tax, but do want to cap that exclusion.
Kevin McKechnie: The first effort will be the repeal of the Cadillac tax, will that be swept up in whether you repeal or you tinker with the ACA. If I had to bet today, they will mend it as opposed to end it because we have a divided Congress if the Democrats take the Senate and GOP retains control of the House.
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The choice here is do you take all this pent-up energy and fix things and make it go forward? There is bipartisan agreement for repeal of the Cadillac tax, but there is no bipartisan agreement on what to do with the risk corridor of payments to insurers.
The fulcrum on all of this swings is will the House Republicans pass an insurer bailout to repeal the Cadillac tax and the individual mandate and company mandate? All of that is in play.
EBN: If the GOP has a very good year, would the ACA be repealed completely?
Abramson: Since 2011, the ACA was a year old, I said at a conference that even if the Republicans manage to repeal it, some of it is going to come back. I do not believe there is a political appetite to go back to the days of no pre-existing condition prohibition. If Republicans say they are going to repeal the ACA they are going to get creamed.
Now, this framework exists and I think that if they want to repeal, the framework generally exists and they will keep some aspects. What they will do is they will build on that and probably expand on it.
EBN: Parental leave has been an issue for both candidates. Will it be a top priority?
Abramson: As for parental leave, I do think there is an appetite there on the Democratic side with Sec. Clinton, but Mr. Trump has also made parental leave one of his issues a couple of weeks ago. That is probably the next frontier, so to speak. It is very unusual to have a Republican advocate for these things. But the first thing will be ACA and Cadillac tax and address the carriers dropping out because they cannot afford it.
EBN: Kevin, will parental leave be a top issue once the new president is sworn in?
McKechnie: No, because it costs money. I haven’t seen a proposal for a revenue offsets yet, so what strategy will emerge congressionally to support this presidential ambition, to give everyone this new entitlement? I haven’t seen this yet. But this is the building blocks of how government works.
So today on the campaign trail it is fine — it’s a laudable goal — but the reality is we work on the resources of this country. Who is going to take this hit so that this new campaign ambition can be sold?
EBN: With all due respect, we have gone to war without having plan to pay for it. Why wouldn’t parental leave follow this tradition, too?
McKechnie: Mostly because the deficit is twice what it was supposed to be. The hawks on the Republican side in the House are very cost conscious right now. We can’t even work on bills that cost $1 billion to $10 billion. Flood insurance is a good example. That came out of a unanimous house vote. That is not like seeing a unicorn, that is like knowing the guy who rides the unicorn.
That did not turn into actual law. If you want something as ambitious as this, there should be a ground swell in the country that makes you overcome what in the Senate is a budget point of order. If it can overcome that, you can add it to the debt and it becomes a program. If you cannot overcome that, you have to find some way to pay for that.
I haven’t seen that emerge. It looks like an unfunded partnership between the presidential candidates and Congress.
Why wasn’t healthcare more of a topic in the recent debate, and will it be a topic going forward?
McKechnie: I don’t know and I am very jaded on the subject and here’s why. There are very few rewards for healthcare reform. When George W. Bush passed the largest expansion in entitlement history — the passage of Medicare Part D — he was loudly besmirched for it. And that’s why the only reason conservatives in the House were brought to bear on it, there were no rewards on the ballot box. How did Barack Obama do when the ACA passed? He lost both houses of Congress by massive margins.
There are no rewards for engaging in this because there is no truly satisfactory way to make everyone in the country happy. It’s going to cost a great deal of money and the benefits are not going to be as robust as anybody thinks and it’s linked to a variety of different dynamics in our society.
It could also be that these two candidates enjoy fighting with each other and we just haven’t gotten to that part.
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