What the presidential candidates’ positions on the ACA mean for employers

As you certainly know, we are in the heart of the presidential campaign season. With all of the focus on the horserace aspect of the democratic process, it can be difficult to dig into details of policy. With that in mind, here’s a closer look into where the candidates stand on healthcare, and specifically the Affordable Care Act. We’ve also put together an interactive, nonpartisan matrix on each of the candidate’s positions, which you can find here.

Now, it’s true that the Democrats are generally in favor of continuing the ACA, while Republicans are all promising to repeal it. However, there are important nuances in each candidate’s position. Importantly for employers, all of the remaining candidates say they intend to repeal the Cadillac tax. That doesn’t mean you can ignore the impending tax, but it’s certainly an important development to keep an eye on once we have a new president.

While Democrats Hillary Clinton and Bernie Sanders both support the ACA, they have indicated they intend to make adjustments to it so that citizens pay less for coverage. For Clinton this means, among other things, lowering deductibles and the cost of pharmaceutical drugs. Clinton has also promised to “take on” big insurance and pharmaceutical companies. Sanders, perhaps predictably, has indicated that he prefers a single-payer system, which he has called his “Medicare-for-all” plan.” Clinton has called into question Sanders’ ability to deliver on such an expansive healthcare system and has said in the debates that her plan will more closely resemble President Obama’s plan.

On the Republican side, there’s a contest to see who can hit the ACA piñata the hardest, and they’ve all promised to repeal the Act. For the most part, the candidates would like to give more power and responsibility to consumers, arguing for health policies that embrace flexibility, portability and free-market principles. Ted Cruz has voted to repeal the ACA and has proposed the “Health Care Choice Act” as an alternative. He recently said on the campaign trail that he’d like to unbundle health insurance from employment. Marco Rubio, John Kasich and Ben Carson have all discussed increasing consumerism, and have proposed several ways to make that happen.

Both Carson and Jeb Bush have discussed changing Medicaid; Carson wants to completely overhaul it, while Bush wants to give more power to the states. Donald Trump has also talked about returning authority to the states, and allowing individuals to more easily buy insurance across state lines.

At this time, only a few of the candidates have released very detailed healthcare proposals, making it difficult to determine precisely how their presidency will impact your organization’s benefit plans and policies. However, one thing is clear, plans to eliminate the current employer-sponsored health insurance model (whether through a single-payer system or otherwise) could have a devastating effect on your organization’s ability to recruit and retain the best workers. Further, such plans may involve eliminating or eroding the current tax benefits for employer-sponsored health insurance, which no employer wants to see.

Let’s not forget about the fact that little has been said about what will replace the ACA. For the last several years, there has been a lot of talk about repealing the law. Our position all along has been that the ACA, in one form or another, is here to stay. Despite the Republican candidates’ universal vow to overturn it, there’s no guarantee that Congress will go along with the plan, and there’s certainly a chance that at least one Republican candidate changes his mind.

These candidate positions are worthy of our close attention. The health insurance policy debate is more than just an ongoing conversation on the campaign trail. It’s a vital discussion that directly impacts the cost of doing business, whether that means being able to provide adequate health insurance coverage that keeps your employees healthy and productive, or attracting and retaining the top talent in a competitive industry.