It had been only a few hours since his swearing in, but Trump was moving fast. On Friday evening, the 45th U.S. President signed his first executive order, taking yet another step toward fulfilling his campaign promise of repealing and replacing Obamacare. The order instructs agencies to more loosely interpret and delay any fulfillment of the Affordable Care Act policies as permitted by law in order to avoid further economic burden. Though no new law has been made, agencies have been asked to waive or delay the enforcement of fines for the uninsured. This is a symbolic first step in Trump’s presidency as it shows legislators that he will act promptly on the issue as he has said.
There is debate as to whether the over 20 million insured due to the ACA will be lost under Trump’s new healthcare reform. The Trump administration has assured that no coverage is intended to be lost, at least not without a transition period. But the elimination of the Health Insurance Marketplace could disrupt the accessibility to the low-income, uninsured individuals.
With the repeal now underway, it is important to know what will be lost from Obamacare and what will be gained with its less-defined replacement.
The Affordable Care Act, known as Obamacare, has caused major changes throughout its official seven-year lifespan, including providing insurance for over 20 million uninsured citizens. But the program itself is ambiguous to many people and has been described as confusing and poorly explained. Harry, a member of Bikers for Trump who attended the inauguration and subsequent rallies, told The Record that he didn’t “really know what the heck Obamacare” specifically did, while a bystander nodded in agreement.
Obamacare has included a rolling application of hundreds of rules since its introduction in 2010. It was created to provide healthcare coverage to those who were uninsured, improve the quality of care in health plans and decrease healthcare costs through specific rules and regulations for clinical providers, insurance companies and consumers. The basic provisions and rules include:
- Require minimum essential coverage.
This is required for all non-exempt Americans, who will have to pay the mandatory fee of 2.5 percent of an individual’s income, or $695 per adult and $347.50 per child, whichever is greater. Those who have short gaps in coverage (less than three months) will be granted exemption and will not have to pay the fee.
- Expand Medicaid eligibility to millions of uninsured, low-income Americans.
- Set up the Health Insurance Marketplace (Healthcare.gov).
The Health Insurance Marketplace serves as a place for qualified individuals to find government-subsidized health insurance during periods of open enrollment. Qualification for savings is based on income, household size, and state.
- Provide financial subsidies for certain individuals to purchase health insurance.
- Increase employer coverage.
As of 2016, major employers — those with over 50 equivalent full time employees — are required to provide health insurance for employees. Any company that has under 25 of these employees qualify for assistance in covering employees via the Health Insurance Marketplace.
- Protect consumers from being denied insurance due to illness or other health conditions.
- Improve Medicare by reducing out of pocket costs for prescriptions and covering certain preventative services such as mammograms and colonoscopies.
Healthcare reform and support was the subject of many signs at the history-making Women’s March on Washington on Saturday, Jan. 21. Signs reading, “My Body, My Decision” and “Keep Your Small Hands Off My Uterus” were among the more tame. Many women feared that the repeal of the ACA would take away coverage to a wide-range of birth control, including the morning-after pill.
Amidst the hundreds of thousands stood a white-haired couple — the McClures — holding signs in support of Obamacare. When asked why they decided to advocate for Obamacare, Dana said it was because of how greatly her children had benefitted from the program. Their daughter is a physical therapist contracted with a school district, which requires her to find and pay for her own health insurance. Craig explained that his daughter’s husband was a stay-at-home father but has returned to school to study nursing in order to bring in the income needed for their young family. The provisions offered by the ACA, said Craig, have “helped them tremendously.”
Trumpcare — an unofficial name — is the new healthcare reform that will likely replace the Affordable Care Act if Trump follows through with his campaign promise. With only a skeletal description released, it is unclear what exactly the act will change for Americans, though the largest reversal seems to be the elimination of the requirement that everyone be insured. Below are suggested changes to achieve the goal of broadening access, increasing affordability and improving quality:
- Completely eliminate Obamacare.
The Trump-Pence campaign indeed wishes to eliminate Obamacare, while maintaining some of the more popular provisions. This would include the ability for individuals to remain on their parents’ health insurance plans until age 26. It is still unclear how much will actually be repealed.
- Allow the sale of health insurance between states.
This would, according to the campaign, allow full competition and improve customer
- Make health insurance premium payments fully tax deductible.
- Improve access to, and the use of, Health Savings Accounts (HSAs).
These would be of particular interest to younger individuals who can afford plans with a high deductible, which can be passed to other family members. Deposits would be tax deductible.
- Require price transparency from providers.
This is perhaps one of the more drastic changes that could occur with Trump’s plan. Price transparency would mandate that healthcare providers — such as physicians and clinics — display prices for services. Presumably, if consumers know how expensive a procedure or service is, and have to pay for that service out of their own pocket, then they may choose a less expensive option. This would mirror the ACA’s requirement that certain restaurants post calorie counts next to menu items. Jennifer Bell, a healthcare lobbyist in the D.C. area, said she is unsure as to whether Americans will “ever get to the point where cheaper feels better overall.” She said that while cheaper options are adequate, if a loved one gets ill, family members often opt for a more expensive option, which is often perceived as higher quality.
- Give states monetary block-grants for Medicaid to set spending limits.
- Allow access to prescription drugs manufactured overseas.
This would allow consumers to make the best choices about medication with access to cheaper but safe and effective options overseas, according to the release.
For Harry with Bikers for Trump, the tampering with the ACA seems to be more of an attempt to fix something that isn’t broken. “I’ve got my Medicare and my supplemental insurance. Obamacare didn’t bother me,” he said.
On the Trump-Pence campaign website’s healthcare reform report, many have noticed that only one number is mentioned: 11 billion. $11 billion that the U.S. is spending on healthcare unnecessarily, according to Trump, due to lax immigration enforcement and visa-granting. Trump believes that if we “simply enforce the current immigration laws and restrict the unbridled granting of visas in this country,” then these financial pressures could be relieved. However the ACA explicitly states that undocumented immigrants will not be granted insurance under Obamacare.
The Repeal & Replacement Process
Despite Trump’s rush to begin healthcare reform, Obamacare is unlikely be repealed until a replacement is fully formed and ready for implementation. This could take years, according to Bell. Additionally, insurance companies — who are at the frontline of implementing new healthcare rules — need at least 18 months to receive final rules, develop and approve bids and offer the plans to consumers. With no current replacement plan in motion, it could be at least two years before a new healthcare system is activated. The long-term process of healthcare implementation is exemplified by Obamacare, for which full implementation will not be completed until 2022.
According to Bell, one difference between Democrats and Republicans in healthcare policy making is that “Democrats tend to want to dictate very specifically what should happen; they don’t want to leave any room for chance. Republicans are more into flexibility and optionality as long as you meet certain standards.” She noted that this — the strict interpretation of law — was a factor in the Wheaton College v. Burwell case in 2015.
Ultimately, the passing of any healthcare reform will come down to congressional votes, not executive order. The GOP holds the majority in both the Senate and the House, by a handful of members. Over the next weeks, officials, the media and citizens alike will be waiting expectantly for a more detailed explanation of just how President Trump plans to replace Obamacare when he promised, “very quickly.”