President-elect Donald Trump has made it known that he intends to repeal the Affordable Care Act, but to what extent is unclear. He called it “a total disaster” one day and then claimed he supported keeping certain components of the law in place on another. It is unclear what Trump plans to do with the Affordable Care Act. This is the first time since its passing that the new mandates are in real jeopardy of being repealed.
What does that mean exactly? How many provisions would be eliminated? What is the alternative that Trump and his cohorts in the GOP have in mind for replacing the legislation, if any?
There have been conflicting reports as to the time-frame and severity of a repeal. The future is not looking too bright for Obamacare, or the millions of Americans who receive health insurance through the law. The Republicans in the House have voted to repeal it over 50 times.
Now that the party has a majority in the House, the Senate, and the White House in their control for at least the next two years. The clock is running out on the Affordable Care Act as we know it. Unfortunately, many signs point to a return to the previous system that was in place prior to enactment of the federal statute in 2010.
The GOP Effect
Although the Republicans have gained a majority in Congress and have one of their own as President, they lack the number of votes to implement a complete and total repeal. They would need 60 seats in the Senate to make that a reality. Therefore, taking the law off the books entirely probably is not going to happen, at least not in the short-term.
However, what they can do is gut the program by focusing on taking down specific areas of the law in a death by a thousand cuts. They would most likely vote to defund the subsidies for the consumer exchanges and destroy it from within.
Without the subsidy component in place, that would almost immediately result in millions of people losing their healthcare coverage. The GOP knows that targeting this portion of the law is crucial to their goal. That is because part of the mandate contains a clause that permits insurers to cancel any policies written as part of the Affordable Care Act should the subsidies cease.
Republicans could vote to make that happen and the major damage would likely be done to Obamacare. There are some possible exceptions, however, as legislation at the state level could affect how to interpret and carry out the clause. Some people in certain states may still be permitted to keep their coverage but it is unclear to what extent.
The other major part of the Affordable Care Act that the GOP wants to cut is the pre-existing conditions part of the legislation. Before they put Obamacare into law, it allowed insurance companies to deny coverage to anyone who applied for a policy with any sort of health matter, serious or otherwise.
The insurance companies were also able to drop you from a plan if you got too sick. Additionally, they often denied claims for treatment that exceeded an annual limit. They raised prices due to pregnancies and related care. In turn, they were often charged higher premiums.
The healthcare system was badly broken. People were spending their life savings just to fight cancer or treat other conditions. Insurance companies had every right to simply let a patient die instead of paying for the treatments needed, even if the insured was current on all of his or her premiums.
The Affordable Care Act put a stop to these practices. The GOP is all too happy to reinstate them, even though Trump himself believes that the pre-existing conditions portion remain. Yet, nobody really knows what that means. With the new President-elect set to take office in January 2017, we have to wait to get definitive answers.
In January 2016, the GOP passed a bill called The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act. It serves as a proposal for repealing Obamacare. It is not a law but merely the parameters for what their version of healthcare legislation might look like. President Obama vetoed the bill but examining what was inside could give us an accurate assessment of what we are facing down the line.
In addition to ending the subsidies that have been so instrumental in giving millions access to affordable health care, they would also eliminate the Medicaid expansion. This will cut off more than six million low and middle-income people from their coverage. This bill proposed ending the employer mandate portion of Obamacare, as well as the individual mandate.
These parts of the law pertained to the requirements set upon companies to provide their employees with healthcare if both the employer and the employee met certain guidelines, Additionally, the requirements placed on all Americans to have some form of coverage that meet the standards, as described, in the Affordable Care Act, or pay a penalty at tax time.
Any and all language setting strict regulations for companies to ensure everyone and the various consumer protections that accompany them would be repealed entirely. This goes for pre-existing conditions, and the annual dollar limits for coverage each year, as mentioned earlier. Under the GOP plan, companies are able to charge more based on gender and medical history.
Planned Parenthood would get no federal funding. There are restrictions on tax amounts and credits and eligibility for plans that cover abortion. This is outside of any instances that do not fall within the Hyde Protections.
Medicare reforms previously implemented will remain, but qualifying for Medicaid will be more difficult. The new GOP plan would even create a so-called “debt panel”, which is a body that oversees lawsuits brought forth for medication malpractice. Of course, it is not a Republican-backed plan if there were not some form of tax breaks given to businesses. Therefore, this is also a Care Act component.