Donald Trump has been elected as the 47th president of the United States, earning a second term in office. The Republican party also won a majority in the Senate and is poised to take control of the House.
What does this mean for the Affordable Care Act, and — by extension — ACA compliance for employers?
The ACA Moving Forward
While previously in office, Trump unsuccessfully attempted to repeal various aspects of the ACA — all his repeal attempts were ruled unconstitutional.
Previous analyses have shown that more than 50% of individuals enrolled in ACA health plans and receiving PTCs are in Republican districts. This is something the new presidential administration is cognizant of.
Due to the widespread use and popularity of the ACA, Trump’s ACA policy strategy and public rhetoric has changed this go around.
“President Trump is not running to terminate the Affordable Care Act,” Karoline Leavitt, a Trump campaign spokeswoman, said in a statement to the New York Times.” On multiple occasions in 2024, Trump has issued statements indicating he has given up on ACA repeal efforts, and has even attempted to distance himself from his prior repeal attempts.
Given this, we anticipate the key protections and compliance aspects included in the ACA Employer Mandate to remain intact.
The Implication? The ACA Is Here to Stay
The success of the ACA makes it politically difficult to repeal. Last fall, ACA health coverage through state and federal marketplaces reached a record-high participation of over 21 million.
It’s become increasingly risky from a political standpoint for Trump to move forward with any plan to repeal the ACA. Furthermore, Trump’s camp has emphasized that the focus is to improve the ACA in ways that will lower costs. As the Wall Street Journal notes, Trump has also vowed to protect Medicare and bring down healthcare costs overall.
Trump attempted to pioneer price transparency in medical costs during his first term, and is expected to focus that energy on improving the ACA in this next term. The cost of prescription drugs were lowered for the first time in 51 years under his presidency.
“On affordability, I’d see him building on the first term,” Brian Blase, who served as a Trump health adviser from 2017 to 2019 told NPR. Relative to a Democratic administration, he said, there will be “much more focus” on “minimizing fraud and waste.”
Trump has also embraced the “Make America Healthy Again” agenda championed by Robert F. Kennedy Jr., who originally ran as an independent in the presidential election, and has said that Kennedy would have a say in appointments to health agencies. Kennedy, the Journal notes, has said he would target obesity and chronic disease and has mentioned microplastics and artificial food dyes as culprits. He has also said agencies such as the Food and Drug Administration are beholden to the industries they regulate.
Thus, employers should remain vigilant to comply with existing ACA requirements.
Potential Changes to the ACA’s Premium Tax Credits
While it’s clear that the ACA is here to stay, there could be changes. Premium tax credits (PTCs) are tax credits that are paid to health insurance carriers by the government, on behalf of consumers.
In other words, PTCs reduce the cost of healthcare for consumers. Currently, an enhanced version of the PTC is set to expire at the end of 2025.
Premium tax credit will still be available 2026 onwards, but at a smaller dollar amount.
As the growing national debt plays a larger role, some political observers note that PTC’s price tag could become an attractive target for Trump and a Republican-led Congress eager to cut spending. However, if the enhanced PTC is allowed to expire, health care costs will increase for more than 21 million Americans.
ACA Compliance for Employers Remains Ongoing
What is clear is that the ACA’s Applicable Large Employer Mandate under IRC 4980H is not going anywhere. This means that employers with at least 50 Full Time Employees (including Full Time Equivalents) must continue to:
- Measure their workforce monthly to accurately identify ACA Full Time employees;
- Ensure that >= 95% of Full Time employees receive an offer of health coverage that is (a) affordable, and (b) meets minimum value cost-sharing requirements;
- Report to the IRS annually (generally March 31st reporting deadline) using IRS forms 1094-C and 1095-C. Employers report to the IRS on how well they complied with requirements 1 & 2;
- Distribute 1095-C forms annually (generally by March 2nd) to applicable individuals notifying the individual as to their (a) FT status, and (b) benefits eligibility and enrollment status by month.
If you need assistance with ACA compliance and the subsequent year-end filing, contact Trusaic.
Our comprehensive ACA Complete software offers all the resources employers need to achieve full ACA compliance and eliminate penalty risk.
