What You Need to Know — So Far — About the Threat to Obamacare

President-elect Donald J. Trump campaigned on a promise to repeal the Affordable Care Act, also called Obamacare. After he won election, Trump’s website listed it fifth in his list of legislative priorities to be achieved during his first 100 days in office:

Repeal and Replace Obamacare Act. Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds. Reforms will also include cutting the red tape at the FDA: there are over 4,000 drugs awaiting approval, and we especially want to speed the approval of life-saving medications.

What does it mean to repeal the ACA? First, here’s a look at the numbers:

Obamacare statistics

• Covered by health insurance: About 23 million more. That’s the number of people today who have obtained health insurance under the ACA — about half through enrolling in Medicaid and the other half by purchasing private insurance through federal and state insurance exchanges.
• Uninsured: Decrease from 18.2 percent to 10.5 percent. The rate of American adults without health insurance (and who aren’t eligible for Medicare) started falling immediately after the law passed from a high of 18.2 percent in 2010 to 10.5 percent in 2015, according to current figures from the Henry J. Kaiser Family Foundation. People of color, more likely than whites to be uninsured, saw even larger gains in coverage. Rates dropped further in states that expanded Medicaid under the ACA.
• Portion of Americans who want cheaper insurance: Two-thirds. Of the more than 1,200 U.S. adults questioned in a new Kaiser Health Tracking poll, two-thirds said lowering out-of-pocket health insurance costs should be a priority of the new administration. Opinions were split, though, on whether Congress should vote to repeal the ACA: 47 percent were against while 49 percent were for (though that group was split between those who wanted a vote to wait for a replacement, 28 percent, and those who wanted a repeal vote immediately and replacement details worked out later, 20 percent).

What’s happened so far:

Congress begins the repeal

The Republican-led Congress lost no time getting to work. Immediately after the new year and new congressional session began, GOP leaders launched a fast-track effort to repeal Obamacare. They chose a lethal weapon, crafting a resolution that could quickly defund the law even while leaving its regulations in place. The tactic — a type of legislation called a budget reconciliation bill — has two benefits for Obamacare foes:

• It could pass both House and Senate with only a simple majority of votes. Other forms of legislation require larger majorities.
• No filibuster would be allowed. (Filibustering is a parliamentary delaying tactic used by opponents of a bill to prevent a vote from taking place.)

On Jan. 12, the Senate set the repeal in motion by passing, with a three-vote majority, a plan requiring committees in both House and Senate to draft repeal legislation by Jan. 27. The House passed a similar measure on Jan. 13.

No replacement … yet

Defunding the Affordable Care Act immediately would build on momentum from Trump’s election and be a bold starting move for the new president and GOP-controlled Congress. “We’re going to have a health care that is far less expensive and far better,” Trump promised at his Jan. 11 news conference.

Trump advisor Kellyanne Conway told MSNBC’s “Morning Joe”:

“We don’t want anyone who currently has insurance to not have insurance. Also we are very aware that the public likes coverage for pre-existing conditions. There are some pieces of merit in the current plan.”

Insurance still is available

But the speed and force of the move to dismantle Obamacare without, so far, a replacement, triggered an onslaught of criticism, even from some conservatives. Critics say the repeal has been poorly planned, or not planned at all, and could cause tens of millions of people to lose their health insurance.

Meanwhile, though, the government health insurance exchanges still are functioning and any changes probably won’t be felt by consumers this year, many of whom receive subsidies via tax credits under the ACA to help pay their premiums.

In fact, the ACA is still accepting sign-ups for 2017 coverage. The open-enrollment period was extended to meet high demand. Obamacare open enrollment ends on Jan. 31 — the last day you can enroll for the first time or switch plans for 2017. (There are exceptions that allow for a special enrollment period later, including having a new baby, losing health care coverage or other reasons. Even if the law is repealed, signing an insurance contract today means you are covered through 2017.

Far-reaching effects

The discussion of repeal already is creating uncertainty that could have far-reaching effects.

“We do not support this approach to repealing and replacing the ACA because it carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying to finance their health services, and because it is unlikely to produce a coherent reform of health care in the United States,” said Joseph Antos and James Capretta, policy experts at the conservative American Enterprise Institute.

In particular, they criticize the “repeal and delay” approach — meaning dismantling the law now, while delaying the effects of key changes or passage of a replacement plan.

“The most likely end result of ‘repeal and delay’ would be less secure insurance for many Americans, procrastination by political leaders who will delay taking any proactive steps as long as possible, and ultimately no discernible movement toward a real marketplace for either insurance or medical services,” Antos and Capretta wrote.

The American Medical Association wrote to congressional leaders of both parties, urging them not to disrupt people’s medical insurance without having an equally good replacement in place. “[I]t is essential that gains in the number of Americans with health insurance coverage be maintained,” the medical leaders said.

Another sticky problem is that ending Obamacare by defunding it leaves the law’s rules in place — rules, for example, that require larger employers to provide health care coverage for employees and that require employees to prove they’re insured or pay a fine.

It is too early, though, to tell if worries about health insurance market chaos will be realized. Keep watching Money Talks News for more coverage of the costs and consequences to consumers.

How do you think a repeal of the Affordable Care Act would affect you? Share with us in comments below or on our Facebook page.