Taking-up the Reins

Imagine a horse and carriage. What comes to mind? Perhaps tourists in quaint buggies exploring city streets, or maybe a picture-perfect wedding with a beautiful white horse pulling a gleaming carriage. But did you think of a thrilling international sport that puts both horses and drivers to the test? Welcome to the world of combined driving.

For those unfamiliar, combined driving is an adrenaline-filled competition that demands skill from both the driver and the horses. At the sport’s highest level, the carriage is pulled by four horses, known as a four-in-hand team, guided by a driver who controls the horses using reins, a whip, and vocal cues. It’s not a solo act, though. The driver has two critical partners: the groom and the navigator. The groom manages the harnesses and helps balance the carriage, while the navigator stands ready to assist in the wildest phase of the sport: the marathon.  Picture a high-speed adventure through obstacles like water jumps, hills, and bridges. It’s a race against the clock, where control and teamwork are everything. Check it out here!

Similarly, President-elect Trump is preparing to steer the “four-horse team” of key parts of the U.S. healthcare system: the Affordable Care Act, Medicare, Medicaid, and employer-sponsored coverage. Let’s take a look at what the future may hold for each member of this healthcare team as Trump takes the reins in January.

#1: Platinum Assurance – The Affordable Care Act (ACA)

Platinum Assurance, or “Plat” for short, is the youngest but one of the most popular horses of the team, with over 20.8 million enrollees in 2024. Despite its widespread support, President Trump has hinted at major overhauls, with proposals like shifting to medical underwriting, which could raise costs for sicker individuals while benefiting healthier ones. ACA subsidies may also be reduced or eliminated, potentially making coverage unaffordable for many.

Trump’s team might revive expanded short-term health plans, which are not subject to the Affordable Care Act’s consumer protections, including guaranteeing coverage for people with preexisting conditions. Under President Biden, final HHS rules limit the duration of the insurance plans to three months, with the option of a one-month extension and plans are required to provide consumers with a clear explanation of the limits of the coverage they provide.

#2: Gray Monarch – Medicare

Gray Monarch, affectionately known as “GM,” is an older but equally beloved horse, but it could face big changes. Experts predict that the new administration will focus on Medicare Advantage plans, moving away from traditional Medicare as the default option, as outlined in Project 2025. Provisions like the $35 monthly insulin cap and the $2,000 out-of-pocket cap for seniors might also be on the chopping block. And for over a million reproductive-age women on Medicare due to disability, the threat extends to current reproductive health coverage, including abortion access and birth control.

#3: Guardian Gray – Medicaid

Guardian Gray, or “GG,” provides health coverage to low-income families, pregnant women, people with disabilities, and those needing long-term care. Policy experts warn that the Trump administration may attempt to eliminate Medicaid expansion, a part of the Affordable Care Act. There’s concern that Medicaid’s federal funding could be converted into block grants or per capita caps, reducing federal protections and undermining the program’s ability to serve those who rely on it most. Work requirements for Medicaid, previously approved under the first Trump administration for 11 states but only implemented by one due to court challenges, could return after being rescinded by the Biden administration.

#4: Steel Resolve – Employer-Sponsored Coverage

While Steel Resolve, better known as “Steely,” has largely stayed out of the spotlight, some changes may still be on the horizon. Experts speculate Congress might attempt to cap the employee tax exclusion or employer tax deduction for health coverage. The No Surprises Act’s dispute resolution process could be replaced by a truth-in-advertising approach, which will require consumers and out-of-network providers to resolve disputes themselves. Health Reimbursement Accounts (HRAs), Individual Coverage Health Reimbursement Arrangements (ICHRAs), and other similar vehicles may also see expanded roles, reshaping employer-provided benefits.

As Trump takes the reins on January 20th to guide the “healthcare carriage,” many Americans are watching closely to see where he will lead this crucial four-horse team. The ride ahead is poised to be anything but straightforward. The course is littered with obstacles, from political opposition to potential policy missteps.

There’s a real possibility that the changes being proposed — whether to the ACA, Medicare, Medicaid, or employer-sponsored coverage — could create chaos rather than stability, leaving many Americans vulnerable to losing critical healthcare protections. The ride ahead promises to be intense, with sharp turns and moments of high drama that could shake the very foundation of the nation’s healthcare system. Stay tuned to see how the ride unfolds!

Happy reading,

Enjoy the weekend!

Best,
Suzanne
Suzanne Daniels, Ph.D.
AEPC President
P.O. Box 1416
Birmingham, MI 48012
Office: (248) 792-2187
Email: [email protected]

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