Obamacare is close to death after Trump's election

Bob Bryan
Business Insider
barack obama sad american flag
barack obama sad american flag

(Ty Wright/Getty Images)
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 ACA was an "unpopular law" and that Congress has already proven it could "repeal and replace" it.

Additionally, Senate Majority Leader Mitch McConnell said that repealing the ACA was a priority for Republicans.

"It's pretty high on our agenda, as you know. I would be shocked if we didn't move forward and keep our commitment to the American people," McConnell said at a press conference on Wednesday.

Trump spent a significant part of the final weeks of 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While the law can't be fully repealed, according to Timothy Jost, a professor at Washington and Lee University and advocate of the law, Republicans could use measures to defund much of the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 could remove funding for tax subsidies that 84% of the people getting their healthcare through the exchanges use to afford care. Trump and the Republican-controlled Congress could also roll back Medicaid expansion and stop outreach efforts to get people to sign up for plans through the exchanges.

Cynthia Cox, a health policy expert at the nonpartisan Kaiser Family Foundation, said that because Republicans don't control a filibuster-proof majority in Congress, they would only be able to use budget reconciliation measures to change the ACA.

This means that only parts of the law related to funding could 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. He said that 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 said that those people are "at risk" of 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," Cox said. "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 doesn't match with 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 favor 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 of insurers to deny people based on a preexisting condition.

"Some of the coverage aspects of the law would stay in place," Cox said. "Gender rating where women can't be charged more than men, older people can only be charged three times more than young people, younger people can stay on their parents' insurance until they're 26 — 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," Jost said. "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 period right now, Americans could be discouraged from getting health insurance through the exchanges if they think they will soon be gone.

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