Throughout the campaign, President-elect Trump promised that one of the first things he would do as president is to repeal the Affordable Care Act (ACA), more commonly known as Obamacare. However, he has also repeatedly promised to replace the ACA with a plan that is less costly, provides better benefits and offers coverage to more people. In interviews, he has said that he hopes to repeal the ACA and simultaneously replace it, possibly within the same day, with a new plan. Many experts say that repealing and immediately replacing the ACA is impossible and that repealing without a plan in place could put the health of millions of Americans in jeopardy.
Problems with Repeal and Replace
Republicans have already begun the process to repeal the ACA through a Senate budget resolution. Repealing Obamacare will be a lengthy process, one that will be difficult to achieve in just a few days or even months. The process began with what is known as reconciliation, which directs the House and Senate to appoint two committees to write language that repeals the bill. While writing the language for appeal, Congress must keep in mind the 20 million people who have insurance through the ACA as well as the impact on the economy of repealing this massive piece of legislation. There are also disagreements, even among Republicans, about the timeline for replacement and how far-reaching the repeal will be. Some members of Congress have said they will vote against any repeal if there is not an instant replacement ready, and this could lead Republicans to fall short of the votes necessary to repeal the law at all.
What’s at Stake
Republicans staked their election on the repeal and replacement of Obamacare. Now that they’re faced with the practical task of undoing President Obama’s signature healthcare initiative, many are finding it will not be as easy as they thought. They see that repeal and replace has actual consequences, not only on the economy but on individual lives nationwide, and that some of the provisions eliminated could weaken consumer protections. Opponents of Obamacare admit that healthcare prior to the ACA was not working, and they don’t want to return to that type of system. Unfortunately, even those who want to change the current system are unsure what system will work.
Mandates Under Fire
One of the items under the ACA that Republicans are determined to eliminate is the mandate that requires all Americans to have health insurance or face an IRS penalty. Too many Americans are simply ignoring the mandate and paying the penalty, as the cost of the IRS levy is far less burdensome than purchasing health insurance. In addition, the ACA requires coverage of consumers with pre-existing medical conditions. Republicans, including President-elect Trump, have consistently said they want to keep that portion of the ACA, but keeping it means they will be required to keep other provisions of the law. Democrats say that the only way to cover the cost of medical treatment to people with pre-existing conditions is to require all Americans, including healthy ones, to purchase health insurance. The Republican plan addresses pre-existing conditions by requiring that someone with such a condition have continuous coverage, meaning a lapse in insurance could allow them to be denied coverage. There’s no easy solution to covering higher-risk patients while eliminating the individual mandate.
Loss of Insurers
There is already talk that replacement will not be immediate. Instead, many in Congress say it could be more than three years before the ACA can be replaced, which creates uncertainty in the marketplaces. Insurance companies are not fond of uncertainty, so many believe that insurers will pull back participation from the marketplace, giving consumers fewer options and causing premiums to rise significantly. Aetna and UnitedHealth have already pulled out of the exchanges for 2017 based on lower enrollment among young, healthy consumers. If there’s a delay in replacement of the ACA, many more might follow in an attempt to recoup potential losses.
President-elect Trump has repeatedly said that no one will lose coverage during the process of repealing and replacing Obamacare. However, most experts believe that millions will lose coverage if the law is repealed. Today, there are approximately 28 million Americans who are uninsured, down from 41 million in 2013. The Congressional Budget Office has said that as many as 19 million people will lose coverage or be unable to get new coverage in the first year that Obamacare is repealed. Within a few years, that number could hit 24 million as policies lapse and young people transition from their parents’ policies.
Republican Replacement Plan
As of mid-January, the Republicans did not have a set plan to replace Obamacare, although they immediately began to take steps to repeal it. Even Republicans are concerned about repealing the plan without a concrete replacement. Many lawmakers believe that Trump’s desire to repeal and replace is overly ambitious, pointing to the fact that it took more than a year for Democrats, who controlled the Senate at the time, to pass the initial bill.
Representative Tom Price, who has been nominated as secretary of health and human services, has not been approved by Congress. Trump has said that Price will play a key role in shaping the replacement plan. Unfortunately, the Senate Finance Committee is still setting confirmation hearings, and Democrats have promised to undertake a “no-holds-barred blitz” of his record during his confirmation, a tactic that could delay his confirmation. Political commenters suspect that the plan that will replace the ACA will be a hybrid of House Speaker Paul Ryan’s “A Better Way” proposal and the seven-point plan discussed by President-elect Trump while on the campaign trail.
Speaker Ryan has said that there will be a full conversation to discuss the repeal and replacement of Obamacare during a Republican retreat planned a week after the inauguration. He said that the budget reconciliation process is just the first step to gutting major parts of the ACA and determining which portions to keep, including the pre-existing conditions clause. Senate Finance Committee Chairman Orrin Hatch has said that Congress could include repeal wording that would allow states to provide some healthcare coverage decisions before replacement is implemented. Adding to the tumult is the fact that replacement would require 60 Senate votes, which the Republicans do not have. Therefore, some portions of the bill may remain, such as the Children’s Health Insurance Program, in order to convince Democrats to vote for the new healthcare plan.