What is the future of Obamacare? Obamacare, or the Affordable Care Act (ACA), has become the most infamous and controversial pieces of legislation in US history, with the Republican party voting an astonishing 63 times to attempt to repeal or limit the law over the past six years. And now that Republicans have power in two branches of government, the ACA may be dead in the water. The bill should have gained unanimous support, given that it merges the liberal dream of a fully state-sponsored healthcare system, with the Republican ideals of a free market for insurance companies. However, this legislative compromise only led to a stalemate wherein neither side was truly happy.
Given the Republican’s aversion to the ACA, one would imagine it has had horrific consequences for the electorate. Yet it has managed to extend health insurance to 22 million formerly uninsured people across the country, bringing the uninsured rate in the US to an all-time low of 8.6 percent, and allowing low-income families access to healthcare they wouldn’t have previously been able to get. And more than 80 percent of people who buy insurance qualify for some subsidies.
But that doesn’t mean that the legislation is perfect; premiums have risen severely over the last year. And then there’s also the rising drug and healthcare costs, and if the law is kept in place they may continue to rise. It is unclear to us, at the moment, whether Republicans will follow through with their promises to immediately repeal the legislation and change the future of Obamacare, whether the Democrats currently lining up behind Bernie Sanders will successfully oppose this repeal, or if President Trump would even sign the bill were it to pass.
Future Of Obamacare: Rising Premiums
Without a doubt, the biggest criticism of Obamacare has been the rising premiums. Insurers intentionally set them artificially low in the first years to win market share. For example, the average increase of the mid-level silver plans was 16 percent — though the changes varied significantly across the country. In Arizona, the average premium more than doubled, from $196 per month to $422, whilst in Indiana they dropped 3 percent to $299 per month. On top of that, around 77 percent of current enrollees have still been able to find ACA plans for less than $100 a month, once subsidies have been taken into account.
It should be noted that there have been questions raised as to how premiums can be allowed to rise, whilst insurance companies are recording ever-rising profits – insurance provider Aetna reported a record $734 million in profit on $15.8 billion in revenue in three months, from July to September.
Republican Plans
What many people fail to realize is that the ACA was essentially a Republican plan. Obama and his colleagues tore it right out of Mitt Romney’s play book in the wake of the 2008 election. The idea of having insurance exchanges and private insurers was a big bone thrown to the Republicans, as they were totally opposed to the idea of a government single-payer option. Obama was quick to point this out in a 2010 interview with NBC, stating that:
“A lot of the ideas in terms of the (health insurance) exchange, just being able to pool and improve the purchasing power of individuals in the insurance market, originated from the Heritage Foundation.”
The individual mandate, the clause that fines people for not having insurance coverage, has been incredibly unpopular, and was also a Heritage Foundation (a conservative think tank) idea. The individual mandate is a key factor in ensuring lower insurance prices across the board, by having complete (or close to complete) coverage, insurance prices will drop for everyone. The problems arise when there is a lack of competition to drive prices down; consequently, some people prefer to pay the fine rather than pay for health insurance that isn’t in their budget.
In a recent interview with Vox on the issue of the ACA, Barack Obama was openly critical of the shortcomings of the program, stating that competition could be increased by offering a public option in areas where there was very little competition. He also felt that subsidies could be increased for a wider range of low-income families.
According to the McKinsey Center for U.S. Health System Reform, 17 percent of Americans eligible for an Affordable Care Act plan may have only one insurer to choose from next year. It remains to be seen as to what the Republicans will do with the opportunity that lies ahead of them.
President Barack Obama Vox interview with Ezra Klein and Sarah Kliff about Obamacare:
Repeal And Replace?
After six years of endless (and arguably pointless) votes to repeal the law, it would be natural to assume that the Republicans had a plan to ensure people won’t go without healthcare. One of the main plans being touted involves a repeal and delay replacement for several years, however that plan has come under heavy criticism since there is no obvious replacement that has been put forward as of yet.
In a pre-emptive move last year, Republicans passed the Restoring Americans’ Healthcare Freedom Reconciliation Act, which means that much of the ACA could be repealed by a simple majority and the Democrats wouldn’t have the ability to filibuster the bill in the Senate. However, the requirement to cover those with pre-existing conditions would be left partially intact, as would allowing children to remain on their parent’s insurance through age 26. But, despite years of championing the anti-Obamacare rhetoric, the Republican party now faces an uphill battle to reach this “Holy Grail” of modern conservative ideology.
A Misinformed Electorate
The public opposition to the bill seems to come primarily from Republicans stirring up the populace against Obamacare. A poll by CNBC showed us that the mere association with Obama’s name slant’s people’s view of the Affordable Care Act, in both positive and negative lights, with 29 percent of those polled supporting Obamacare, while 22 percent supported the ACA, and 46 percent opposing Obamacare, while 37 percent opposed the ACA. Although it may be a little extreme, this video segment by Jimmy Kimmel perfectly encompasses this disparity of knowledge that the public has about their healthcare system:
Despite this misunderstanding of the legislation, the fact that some 22 million people are likely to lose insurance if the law is repealed means that to simply repeal the law would be an incredible unpopular tactic. A post-election poll, by Kaiser Family Foundation, showed that only 26 percent of respondents were in favor of repeal – now that’s what I call political suicide. Similarly, many Trump voters from Kentucky, have expressed fears that they would lose their coverage if the legislation was repealed. Miners and ex miners are currently receiving treatment for black lung disease through Kentucky Kynect (a rebranded ACA marketplace) and that their coverage would be torn away if the law was abolished.
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What Has Trump Said About The Future Of Obamacare?
It can be difficult to wade through Donald Trump’s statements on any topic to attempt to find a clear direction or policy, and healthcare is no exception. Although he was incredibly critical of the Affordable Care Act on the campaign trail, he also guaranteed to fight for those people to remain insured under his regime. On January 5th, he actually tweeted
…time for Republicans & Democrats to get together and come up with a healthcare plan that really works – much less expensive & FAR BETTER!
— Donald J. Trump (@realDonaldTrump) January 5, 2017
This may seem a little at odds with the Trump we got to know on the campaign following his repeated claims that he will repeal the “disaster that is Obamacare”, but Trump may be more in favor of an expanded system than many realize. In August 2015 Trump praised the single-payer system in Canada and Scotland saying:
“As far as single-payer, it works in Canada. It works incredibly well in Scotland. It could have worked in a different age, which is the age you’re talking about here.”
And a month later stated:
“I am going to take care of everybody … I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”
(Side note: Scotland has a socialized health service like the rest of the UK, not a single-payer one)
So from the looks of things, Trump doesn’t want to utterly destroy the future of Obamacare, rather reform it slightly. In fact, we got a glimpse of how this might look during that interview. He is in favor of allowing insurance companies to sell outside of the state they are based in, although that has the potential to cause all sorts of jurisdictional problems.
Regardless of his campaign promises to repeal the ACA and change the future of Obamacare, it seems like there is a possibility of reform laws being passed. Incidentally, repealing the law, according to Congressional Budget Office, would increase the deficit by $383 billion over the next 10 years or $137 billion under positive economic assumptions.
With that said, there may be some serious opposition from Republicans who want it repealed after years of symbolic votes. Trump, already a seriously unpopular President, would be foolish to abandon so many voters who believed that he would take care of them.
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