Prognosis: Uncertain: employers watch as obamacare reform stalls.

• Author: Jackson, Margaret
• Position: HEALTH REPORT

As President Donald Trump confronts obstacles in his pledge to dismantle the Affordable Care Act (ACA), questions and concerns continue over what a new health-care coverage system will look like--if a new system emerges at all.

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Since Congress approved the ACA in 2014, about 20 million Americans who previously didn't have insurance now do. But the burden of complying with the ACA, also known as Obamacare, has been onerous, and one of Trump's first orders of business on the day he was sworn in was to direct federal agencies with responsibilities related to the ACA to take all actions to the "extent permitted by law" to mitigate economic and regulatory burdens of the law.

Trump's initial effort to overhaul Obamacare failed in March when House Speaker Paul Ryan concluded the replacement bill wouldn't garner enough support and canceled the final vote.

Though Trump said he planned to preserve some pieces, such as prohibiting insurance companies from denying coverage based on pre-existing conditions, there are ideas being floated that would result in higher deductibles, flimsier coverage and increases in the number of people without health insurance.

The uncertainty that's swirling is worrisome to insurance industry experts and the companies they are trying to guide through the complicated process of providing health benefits to their employees.

"The primary concern is instability," says Leo Tokar, senior vice president and client service executive in Lockton Companies' Mountain West Series. "No one claims that ACA is perfect or ideal by any means, but businesses have spent a lot of time adapting to the law of the land. That's required a lot of work with regulatory agencies."

Concerns range from escalating costs to preserving the vehicle that allows companies to administer their plans on a consistent basis throughout the U.S. But perhaps the issue most troubling to employers is whether the income tax exclusion for employer-sponsored coverage will be preserved.

"Traditionally, employer-provided group health plan benefits have always been tax free," says Mark Restum, senior compliance consultant for Arthur G. Gallagher & Co.'s Western Region. "If you tax the value of those benefits, it's going to hurt employees or the employer will reduce the value of the benefit."

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