President-elect Donald Trump has repeatedly promised to repeal the Affordable Care Act and replace it with something, well, more affordable.

Beyond that broad declaration, though, Trump has been less than forthcoming with details about what exactly he would do, leading to widespread uncertainty in the health care industry. (And in an interview with CBS over the weekend, he said he wanted to keep certain aspects of the ACA: "See "Trump now wants to keep popular Obamacare provisions, scrap the rest.")

Nonetheless, there are many things companies, health care and otherwise, can be doing now to prepare for the potential dismantling of the six-year-old law, experts say.

1. Know who's representing you

General counsel should be communicating with their company's trade association to ensure that what the organization is fighting for aligns with the company's best interests, says Eugenia Pierson, senior policy advisor and head of health care legislative advocacy at Arnold & Porter.

This includes doing a "gut check" about which ACA provisions have been effective for the company and which have been challenging, she adds. "Think through who's representing you in Congress and make sure those agendas are on track, that they're the same," Pierson says. "And to the extent they're not, consider getting engaged."

In terms of the intensity of activity among stakeholders, legal departments should prepare for a landscape similar to that in 2008, 2009 and 2010, Pierson says. "If I were a GC, I would want to plan for that level of engagement as the new administration starts to think about how they're going to unwind [the ACA] and what they're going to replace it with," she says.

2. Do an inventory and evaluation

Large self-insured employers also should be looking at their current insurance coverage, including the types of benefits they offer their employees today, says Michele Madison, a partner in the health care practice of Morris, Manning &, Martin.

Adds Sandra Hunt, a principal in PwC: The company should "do an inventory of what they've changed in benefit design specifically because of the ACA and evaluate what has been beneficial for them."

This includes an examination of the number of part- versus full-time employees, Madison and Hunt say.

With the repeal of the ACA, a provision of which requires large employers to offer affordable health coverage that provides minimum value to full-time workers, "you could see more people going full time," Madison says.

Photo: iStock

3. Always remember compliance duties

Don't ignore your continued compliance obligations under the current ACA, says John Chesley, a partner and longtime member of the health care group at Ropes & Gray.

"The pressure on providers to self-examine and self-report has been ratcheted up and made the compliance environment hotter," Chesley says. "It's an important source of focus for the government, and [Trump] has made clear that he wants to reduce waste, fraud and abuse, so that agenda is going to continue."

Such compliance includes meeting the March 31 deadline for employers and health coverage providers to report certain coverage information to the IRS, says Warren Kingsley, a partner and leader of the employee benefits practice at Arnall Golden Gregory.

Companies should be collecting that information from vendors now, as the government, unlike last year, has not yet announced an extension to accommodate unprepared vendors, Kingsley says.

Employers also should keep detailed records, including employees' dates of hire and hours worked per month, to support the information included in the report, he adds.

4. Health care companies have unique considerations

For health care companies, make sure your regulatory, compliance and government affairs departments are operating as they should and communicating with one another so that all relevant parties are aware of the game plan, says Arnold & Porter's Pierson. "The GC needs to make sure that there is a cohesive strategy and that everyone is communicating to the extent that when changes do come, everyone stays focused on whatever that common strategy is," she says.

In addition, regardless of what a revamped ACA precisely would look like, we can expect "consumer-driven health care," based on the premises of deregulation and increased competition to reduce costs, says Morris Manning's Madison.

This means increased competition for hospitals, but, on the other hand, more opportunities for them to grow and develop new facilities, Madison says.

Also, the elimination of the essential health benefits, coverage of which is required by the ACA, could allow patients to "pick and choose," she adds.

Thus, health care companies should be asking, "'What are the services we think patients want the most? Where do our elective procedures come from?' and then developing resources around those service lines that patients would utilize," Madison says.

Finally, if the Republicans replace the ACA's subsidies with the House's "Better Way," which was adopted last summer and calls for refundable tax credits and health savings accounts, fewer people could afford insurance, so hospitals should be thinking about their charity care programs, says Thomas Bulleit, a partner at Ropes & Gray.

"What will that mean for the kind of care they are required to provide? What will that mean when they have more uninsured people showing up again?" Bulleit says.

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How employers & general counsel can prepare for changes to the ACA

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