Update: On February 16, the New York Times reported that Republican congressional leaders had proposed the outline of an Affordable Care Act/Obamacare (ACA) replacement plan that had the blessing of President Trump. According to that report, the main elements of the plan fall in line with the long-favored elements that are discussed in this article. Specifically, the end of progressive tax credits, the institution of age-based ones, health savings accounts, and deregulation that would allow people to purchase insurance across state lines.
Money for high-risk pools was also mentioned, as was a general easing of the coverage standards put in place by the ACA. The biggest addition will impact Medicaid and already strained state budgets across the country, which we’ll address at the bottom of this article.
Approximately twenty million people have moved away from the ranks of the uninsured and improved their prospects for a healthier and more financially stable life because of the Affordable Care Act/Obamacare (ACA), but it hasn’t been perfect.
When the Obama administration was putting together its legislation, it was wrought with compromises, and like any massive remedy, it has had a different impact on different people. In some states, Medicaid expansion has been walled off, and some have not been able to keep their doctors or their existing insurance, despite promises to the contrary.
More recently, premium increases have driven a lot of the antipathy toward the ACA effort, allowing a negative view of the legislation to take hold. It’s important to push past the broad and hysterical claims, though. For one, employer-sponsored plans are how most Americans get their coverage, and while their cost has continued to grow since the ACA, the increases have been less sharp year to year than they were before the ACA. In 2017, the premium cost for a large employer-sponsored plan is expected to go up 6% from last year. Which is more than inflation but far less than what people will face on the ACA exchanges for their private health insurance premiums.
Though it varies greatly from state to state, premiums are expected to rise by 22% on average (with subsidies rising, as well). Why? In part, it’s because the high cost of insuring the sick and covering prescription drugs (whose costs are ballooning with little help in sight) is impacting the insurance companies who pass the hurt on to consumers (even though that hurt isn’t always the case or always evident in the bottom line).
All of these problems are made more prominent because 18-34-year-olds never signed up for coverage at the level needed. Apparently, so-called, “Young Invincibles” are undeterred by the risks of sudden illness or the piddly mandate penalty that is supposed to convince them to sign up and offset the cost of sick people who actually use their benefits and cost the insurance companies.
Is all of this fixable? Conceivably, but while Sen. Lamar Alexander (R-Tennessee) and Sen. Orin Hatch (R-Utah) have gently (and recently, in an about face) broached the word “repair,” and while a Kaiser survey showed that more people view lowering costs as a priority than they do a repeal of the ACA, adapting Obamacare seems like the least likely result.
While the end of the ACA is almost certain, though, there is a lot of uncertainty about what comes next, and only a few staples seem to be consistently discussed among the key players in the effort to find a new way on healthcare. Here’s a look at those elements and how they could impact you.