There is an overwhelming chance that the Affordable Care Act, better known as Obamacare, is facing its last few months of existence as we know it.
For the past few years, congressional Republicans have taken symbolic vote after symbolic vote to repeal Obamacare. And now, with control of the executive branch, these votes will probably become more than just a statement.
In a press conference Wednesday, House Speaker Paul Ryan said the law was an “unpopular law” and said the Congress has already proven it can “repeal and replace” the ACA.
Trump spent a significant part of the final weeks during the campaign railing against the health law, calling it a “bad deal” and highlighting recent premium increases for the ACA’s exchange-based plans.
While the law can’t be fully repealed, according to Timothy Jost, a professor at Washington and Lee University and advocate for the law, Republicans can use measures to defund much of the financial support for the law. The results of the election, he said, has put it “on life support.”
Jost said congressional Republicans and Trump can remove funding for tax subsidies that 84% of the people getting their healthcare through the exchanges utilise to afford care. Trump and the Republican-controlled Congress can also roll back Medicaid expansion and stop outreach efforts to get people to sign up for care through the exchanges.
Cynthia Cox, a health policy expert at the nonpartisan Kaiser Family Foundation, said that due to the fact Republicans do not control a filibuster-proof majority in Congress, they will only be able to use budget reconciliation measures to change the ACA.
This means that only parts of the law related to funding can be affected by the new government.
All in all, more than 20 million people may lose or be priced out of their health coverage after these moves according to Jost, which he said would have a huge effect.
“Some of them will die,” Jost said. “That’s what happens when you lose health coverage. People who maintain their coverage will be under serious financial stress. It will be bad for hospitals because they have to accept more people without care.”
Cox, for her part, said that those people are “at risk” for losing their coverage, but it is unclear what it will look like.
“The details of Trump’s plan aren’t there yet that would help us understand complex way these things will play out,” said Cox. “We aren’t sure if there is a part of his plan to help people keep their coverage or what they would look like.”
For one thing, Cox said, the plan Trump has proposed does not match with the plan from congressional Republicans previous replacement attempts.
Republicans, including Ryan, have floated plans that would bear some similarities to Obamacare, including tax credits to ensure continued expansion of coverage and methods of providing care for patients.
Trump’s health plan has been less clear, but he has mentioned “doing away with the lines” between states. This appears to mean that state regulation of health insurance — all 50 states have their own insurance commissioners and regulation agencies — would be done away with in favour of unified regulations. The exact coverage proposals are unclear, according to Cox.
These moves, however cannot affect some of the other measures such as the inability for insurers to deny people based on a preexisting condition.
“Some of the coverage aspects of the law would stay in pace,” Cox said. “Gender rating where women can’t be charged more than men, older people can only be charged 3 times more than young people, younger people can stay on their parents insurance until they’re 26 [years old]. Those can’t be changed though reconciliation.”
This doesn’t mean the Trump administration couldn’t influence major pieces of the ACA, according to Jost.
“Much of the act is administrative, so a new administration could simply not give it support,” said Jost. “They can not put resources into outreach, discourage people from signing up for insurance through the law instead of encourage, they can dive insurers out of the market. They can cause a lot of trouble.”
Even in the short term, the Trump election could be a negative for the ACA. According to Cox, since Obamacare exchanges are going through their open-enrollment periods right now, Americans could be discouraged from getting health insurance through the exchanges if they think it will soon be gone.
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