What about Obamacare?

Posted 8/21/12

About 22 million or so people have health insurance through the Affordable Care Act (ACA) or Obamacare, and many others, including five people at The River Reporter, have health insurance policies …

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What about Obamacare?

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About 22 million or so people have health insurance through the Affordable Care Act (ACA) or Obamacare, and many others, including five people at The River Reporter, have health insurance policies created under Obamacare reforms.

President-elect Donald Trump has said he will repeal Obamacare “on day one.” It turns out he can’t actually do that right away, because the Democrats have enough seats in the Senate to block a full repeal of the entire law. But Trump theoretically could change it enough that seven million people enrolled in Obamacare could be kicked off their insurance programs almost immediately.

Those seven million people receive federal subsidies to help them pay for their healthcare. But Congress never agreed to fund the subsidies, so President Barack Obama kept the subsidies funded via the budget process. Several analysts say Trump could kill those payments on day one should he choose to do so, and the contracts the federal government has with insurance providers allows them to immediately cancel the affected policies if the subsidy payments are stopped.

Some Trump supporters have said he will not want to offend seven million people by pushing them off the healthcare rolls, and throwing the whole system into chaos, but it remains a possibility.

As it turns out, Trump’s campaign pledge to repeal Obamacare on day one has morphed a bit since the election. The Trump transition website (www.greatagain.gov) says, “A Trump Administration will work with Congress to repeal the ACA and replace it with a solution that includes Health Savings Accounts….” Those accounts would be exempt from taxes. That would be great for wealthy people who can afford to fund them, but they would be essentially meaningless for low-income people who don’t earn enough money to pay much federal taxes—or to save anything—to begin with.

It’s clear that among Republicans there has been a great appetite for the repeal of Obamacare, which the House of Representatives has voted for many times over the past six years. But there are some elements of the law that are immensely popular with the public, and Republicans will likely not want to kill. These include a prohibition against refusing to offer coverage to people with pre-existing conditions, and allowing children up to age 26 to be covered under the policies of their parents. Trump has said he likes these two aspects of the program and would try to preserve them.

But some of the changes that most Republicans want were contained in legislation passed at the end of 2015, which eliminated the federal subsidies given to low wage earners, and the individual mandate, which requires all adults to have health insurance or pay a fine. That legislation was vetoed by President Obama.

Without an individual mandate, there won’t be enough money in the system from healthy individuals to cover the people who have health issues and need treatment. Republicans, however, have long railed against the individual mandate, and they are likely to try really hard to find a way to get rid of it. If they do, it will likely cause more insurance companies to pull out of the Obamacare market and significantly drive up the price of policies. That, according to numerous analysts, would effectively spell the end of Obamacare.

While it seems pretty likely that Obamacare will change, it is not at all clear what that change will look like, and changing will not be easy. Matt Bevin, the governor of Kentucky, ran for office promising to repeal the expanded Medicaid element of Obamacare. The problem was that the program worked really well in Kentucky, and while Bevin made some cosmetic changes, the bulk of the program, including the expanded Medicaid aspect of it, remains intact.

Presidential candidates say many things while running for office. Trump said he would repeal Obamacare and replace it with something “really terrific.” And at other times in his history he has said he supports a single-payer system, which other Republicans would certainly oppose. In an interview on “60 Minutes” in September 2015, Trump said, “Everybody’s got to be covered; the government’s gonna pay for it.”

Despite the many critics of the program, there is still a very strong market for the kind of policies it offers, and people continue to sign up in large numbers. The day after the election, more than 100,000 people signed up for Obamacare in a single 24-hour period.

At this point we can’t possibly know what changes will occur, but we do know that Republicans have been saying since the program was created in 2010 they want to repeal and replace it, and they will control the White House, the House of Representatives and the Senate beginning in January.

Trump has said healthcare is one of his top three priorities going into office. We need chooses an option that takes healthcare away from 22 million Americans, we should be ready to let our representatives know how we feel.

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