Republican lawmakers may face numerous challenges in repealing the Affordable Care Act.
Under former US President Barack Obama, his groundbreaking health law, the Affordable Care Act (ACA), was safe from repeal despite several attempts from GOP lawmakers. The health law is now facing uncertainty under current US President Donald Trump and the Republican-controlled Congress who have pledged to repeal the law as quickly as possible.
Many Americans are wondering if lawmakers will actually be able to repeal the law. While the ACA has not received strong public support in the past, many individuals have been sharing how the ACA has helped them and their loved ones to show opposition to the repeal.
Advocates of repealing the law said that although the ACA reduced the uninsured rate to the lowest in history, it has caused multiple problems and is surrounded by hyperpartisanship, according to a perspectives article published by The New England Journal of Medicine.
If the ACA were more popular, covered influential Americans, or if Democrats and Republicans supported the law, it is likely that reforming the ACA would be the best option for the Trump Administration, the author wrote.
The ACA is facing hardships due to sicker-than-expected patients, insurer withdrawals, high premium increases, and the need for stabilization. By doing nothing, the Trump Administration could damage the ACA exchanges, according to the article.
If the government stopped providing reimbursements to insurers for subsidies given to low-income enrollees, it would severely destabilize the marketplace, which could then lead to more insurers withdrawing from the marketplaces.
Trump has already started to create executive orders that reverse Obama’s previous orders in order to weaken the law, and potentially allow states to opt-out of the insurance exchanges. He has even started the budget reconciliation process to further deplete the law of resources. However, budget reconciliation is only effective to repeal some, but not all, parts of the ACA, the article noted.
Certain provisions, such as those that ban discrimination against preexisting conditions, and allowing children to remain on their parents’ plans until age 26, have been supported by Trump, who said those will remain unchanged. Less popular provisions, such as those that impose a fine on the uninsured and the Cadillac tax, will most likely be repealed due to GOP opposition.
However, because of the nature of the law, many provisions are intertwined, which adds a layer of difficulty to the repeal. Additionally, repealing the ACA without a replacement plan would lead to more than 20 million Americans who are without insurance.
GOP lawmakers could reintroduce a previously vetoed repeal bill that would remove the ACA’s core provisions, according to the article. Even if they move forward with this idea, how will they replace the law?
Trump previously said that he wishes to allow the sale of health insurance across state borders, increase the use of health savings accounts, create high-risk pools, and import prescription drugs from other countries. These actions will not restore health insurance access to Americans, and other components of his desired health insurance reform is largely unknown.
Republicans could use a June 2016 plan released by House leaders that calls for replacing insurance subsidies with tax credits, according to the study. Additionally, this plan would not charge higher premiums to those with preexisting conditions, and would implement caps on noneconomic damages to improve the malpractice system.
Even under these policies, the ACA replacement falls short of ensuring coverage. This plan would result in a large number of individuals becoming uninsured, underinsured, and facing greater discrimination, according to the author.
To craft an effective replacement plan, lawmakers should be able to determine how expansive the plan will be, and how it will be funded. A funding option may be to limit tax exclusions for employer-sponsored insurance, but this may gain considerable opposition, since it would bring an unwelcomed tax increase to reduce health benefits, according to the article.
The threat of the repeal has caused many Americans and lawmakers to speak out in favor of the law and show how much was gained, especially in terms of Medicaid expansion. GOP lawmakers may find that reversing Medicaid expansion will be more difficult compared with dismantling the insurance exchanges.
Additionally, the ACA has accomplished slowing down Medicare spending. If repealed, it is likely that the federal deficit would dramatically increase, according to the article. Payment and delivery reforms, expanded prescription drug benefits, and policies that affect public health are in jeopardy if the law is repealed.
Since reducing health insurance rates is something that will affect the incomes of hospitals, insurers, and physicians, in addition to increasing federal debt, it is not something that should be done rapidly.
Though the Trump Administration is set on repealing the health law, they may face challenges every step of the way in terms of complicated legislation and Democratic opposition. Due to these factors, it is uncertain how or if the ACA will be repealed, the article concluded.