“Piece of cake,” I thought when I was asked a few weeks ago to write an article in early October about the upcoming presidential election. I was confident that, one month before Election Day, we’d have a pretty good idea who our next president will be and how his or her proposals will affect the health insurance industry. Boy was I wrong.

The past year, as political pundits and ordinary Americans know all too well, has been a bit unusual. Our predictions have been proven incorrect more times than we can count, so I think a lot of people have stopped trying to guess what’s going to happen. And that actually makes sense – even if we knew who was going to win, most of us don’t trust what the candidates are telling us. The general consensus is that Clinton is lying about what she wants to do and Trump can’t possibly accomplish all the fixes he’s proposing.

That said, we’re now in the fourth quarter, the busiest time of the year for insurance agents. In the next few weeks, we’ll be visiting with a lot of our clients, and you can bet that some of them will want our thoughts on the election and what it means for their health insurance coverage. So I wanted to give you my two cents…

First, we need to recognize the fact that the president is not a dictator and cannot make sweeping decisions about health care or anything else without some help from the legislative branch. For that reason, when guessing what’s going to happen, we need to look not only at who’s in the White House but also which party controls the two chambers of Congress.

Here are a few possibilities:

1. Clinton wins Presidency – Democrats win control of House and Senate

This scenario is unlikely. While Democrats have a shot at winning the Senate, it’s certainly not a sure thing. Winning the House is much more of a longshot and would only happen if Clinton wins in a landslide. With two presidential debates to go and a potential meltdown by Trump, this isn’t out of the realm of possibility. Still, it’s probably not going to happen given how close the polls are as we enter the final leg of the race.

2. Clinton wins Presidency – Republicans retain control of House and/or Senate

Right now, this is the most likely scenario. Clinton maintains a small lead in most national polls, but it’s not big enough to have a huge impact on down-ballot races. The Republicans are likely to retain control of the House and possibly the Senate even if Clinton ekes (or “EEKS!” for Trump fans) out a victory.

3. Trump wins Presidency – Democrats win control of either House or Senate

This is possible but very unlikely. If Trump ends up winning, we have to assume that Republicans showed up to support him while Democrats did not do the same for Clinton. This would almost certainly translate into a big night for Republicans across the board; they would do very well in down-ballot races as well and would retain or expand the majorities they currently enjoy. The idea that Democrats would show up in large enough numbers to take control of Congress but not cast their vote for Clinton is pretty far-fetched. That leads us to the fourth scenario.

4. Trump wins Presidency – Republicans retain control of House and Senate

This is a distinct possibility. If Trump wins the election, Republicans will likely retain control of both houses of Congress. It’s less likely that they’ll have a filibuster-proof super majority in the Senate, though.

Most Likely Scenarios

Based on all that, the two most likely scenarios are:

• Clinton wins the presidency, but Republicans retain control of at least one chamber of Congress, OR
• Trump wins the presidency, and Republicans retain control of both chambers of Congress.

With that in mind, let’s make some predictions.

If Clinton wins, she certainly won’t get rid of the Affordable Care Act, and Republicans won’t have enough votes to override her veto if they try for the thousandth time to repeal it. With Clinton in the White House, these repeal efforts would be symbolic at best and, more realistically, a huge waste of time – just like they have been with Obama as president.

That means the ACA will stick around, and Clinton has said repeatedly that she’d like to improve and expand the law. Republicans, however, still want it to fail, so aside from a few minor fixes that everyone can agree on, they’re unlikely to approve any big changes to the health reform law. There’s virtually no chance that Clinton’s big proposals, like capping deductibles and out of pockets, expanding Medicaid, or allowing people age 55 and older to buy into Medicare, will pass.

Long story short, other than some regulatory changes, very little will happen to improve the Affordable Care Act during Clinton’s first two years as president. Meanwhile, premiums will continue to increase, plans will require more and more cost sharing, EpiPen-type situations will become more common, and carriers will continue to bail on the individual market. People will demand action, so health care will be a big issue in the 2018 mid-term elections. If voters blame Clinton for not fixing the problems, Republicans could further increase their congressional majority. On the other hand, if people view the Republicans as obstructionists for not expanding Medicare or approving the other proposed changes, they could hand Democrats control of the House and Senate. If that were to happen, we’d likely witness some quick and significant changes in 2019 and, in my opinion, could find ourselves a little closer to a single payer system.

If Trump pulls off a victory (he is a winner, after all – just ask him), he will have the power to undo many of the changes that have been implemented in the past six years and replace them with “something terrific.” It wouldn’t happen overnight, though, despite his claims that he’ll repeal the ACA on his first day in office. It’s already taken six-and-a-half years to implement and we’re not done yet; reversing it could take just as long.

It’s also a little unclear what terrific things he has in mind. We know that Trump wants to expand HSAs, allow for the purchase of health insurance across state lines, and create an individual insurance deduction – three proposals that are supported by a majority of Republicans. Unfortunately, none of these ideas will lower the cost of health coverage nor will they reduce the number of uninsured.

But there are other ideas. Speaker Ryan has his own proposal called “A Better Way” which would retain some of the more popular provisions of the Affordable Care Act like guaranteed issue (sort of) and the age 26 rule. His plan would also eliminate Medicare’s Independent Payment Advisory Board, encourage the use of electronic medical records, and accelerate drug discovery and investment. Unfortunately, Paul Ryan also supports a cap on the employer exclusion which, like the Cadillac tax, could have a negative impact on tax-advantaged accounts like FSAs and HSAs, ancillary benefits like dental and vision, and even worksite products like accident and critical illness that are usually paid with pre-tax dollars. While these are simply talking points at this time and aren’t yet in bill format, they will likely be included in any healthcare legislation that makes it to President Trump’s desk.

My Advice

So there you have it. We don’t yet know who will win the presidency, but we can at least make an educated guess about the impact on the health insurance industry. My advice is that you stick to the facts when talking with your clients about the election. Stay away from the political discussion and instead focus on how the election could affect their business. They’ll appreciate the info and you won’t risk offending them if their views don’t line up with yours.

Now it’s your turn! How do you think the election will affect health care? What are your election predictions? Leave a comment below or email me at eric@freshbenies.com.