What could Obamacare's repeal mean here?

Posted at 7:00 AM, Jan 11, 2017
and last updated 2017-01-11 07:00:20-05

Republican promises of dismantling Obamacare are expected to be fulfilled starting Wednesday as GOP leaders unveil their plans to repeal and replace the health law.

Since rolling out in 2010, President Barack Obama’s Patient Protection and Affordable Care Act has provided health insurance to more than 25 million previously uninsured Americans through expanded Medicaid benefits and online exchanges where consumers can shop for insurance and receive cost-cutting tax credits.

Nationwide, the number of uninsured has dropped to an all-time low of 8.6 percent of Americans under 65. That's down from more than 13 percent before the health law moved into full swing in 2014.

But critics say the law isn’t working.

"Under Obamacare, many have learned that having health insurance isn’t the same as actually having health care," Senate Majority Leader Mitch McConnell said during proceedings in D.C. on Tuesday. "Many Kentuckians have been forced into plans their doctors won’t accept with the cost of premiums and deductibles so high that they fear they can’t afford to get sick. These aren’t the results Kentuckians wanted. These aren’t the results Obamacare promised."

A recent poll by the Kaiser Family Foundation found that 49 percent of the public believes Congress should vote to repeal the law and 47 percent are against a vote. Of those who want to see the law repealed, 28 percent say they want lawmakers to wait until the details of a replacement plan have been announced. The other 20 percent say Congress should repeal the law immediately and work out the details of a replacement plan later.

Meanwhile, enrollment into plans sold through the marketplace has reached an all-time high with more than 8.8 million Americans signing onto new policies through the end of 2016.  

As lawmakers, consumers and insurers consider the road ahead, here are answers to key questions about what Obamacare’s repeal could mean locally and a look at what to watch for:

What’s expected to be changed?

Republican leaders have said they want to craft a plan that gives states – instead of the federal government – more control over regulating health insurance, but details have yet to be shared.

Key pieces of the law that could be eliminated or significantly altered include: Medicaid expansion, federal tax credits for insurance plans sold on the new online marketplace and the mandates that require individuals to have insurance and certain employers to offer it to their employees.

Republicans have said they’re interested in keeping more popular pieces of the law including reforms that prohibit insurers from denying insurance based on pre-existing conditions and allowing parents to provide coverage to children until age 26.

Any proposed changes are expected to take a “repeal and delay” strategy that would allow ACA insurance coverage to continue for at least two years and give consumers, insurers and states time to adjust to the new rules.

Uncertainty unhealthy for healthcare

But absent from the strategy is a formal replacement plan from Republicans.

Experts warn that the uncertainty could be costly for consumers and insurers.

The biggest impacts could likely to be felt as early as 2018 as insurers pull out of the marketplace in anticipation of its collapse, said Linda Blumberg, a health policy analyst and author of the Urban Institute report.

The number of uninsured could jump to 964,000 in Ohio and 486,000 in Kentucky -- more than doubling in each state -- as more consumers choose to forgo coverage or become ineligible for tax credits, according an Urban Institute Report.

“Even if you delay certain repeals, you can cause a lot of disruption and financial difficulty for insurers and consumers right away,” she said.

Will repealing the law save consumers on health insurance costs?

Likely not, according to a Commonwealth Fund-Rand study.

On average, a marketplace policy holder spends about $3,200 out of pocket annually for the premium and for other costs, including as co-payments. The Fund-Rand study found that repealing the law without a replacement plan would increase out-of-pocket costs to $4,700 a year.

Watch for Medicaid overhauls

Ohio and Kentucky are among the 32 states that opted to expand Medicaid coverage to individuals and families earning up to 133 percent of the federal poverty level under the ACA.

That move extended Medicaid coverage to:

- 618,200 Ohioans
- 439,000 Kentuckains
- 222,400 Indiana residents

In recent years, the federal government has fully covered the cost of the expanded coverage for states. But that funding drops to 95 percent this year and 90 percent by 2020.

Some state and federal lawmakers are concerned the costs of the expansion will soon outweigh savings. At least one plan floated by Republican House Speaker Paul Ryan proposes that states should cover up to 35 percent of the costs by 2020.

Meanwhile, Trump has said he wants to turn Medicaid into a block grant program that would cap funding sent to states.

Impact on jobs, economy

Cutting federal spending through overhauls to Medicaid and the health law’s insurance tax credits could have a big impact on jobs across the U.S., according to study but the Commonwealth Fund.

Nationally, a $140 billion cut in federal spending in healthcare by 2019 would lead to a loss of up to 2.6 million jobs, mostly in the private sector, according to the report.

Ohio would be among the hardest hit states, with a projected 126,000 jobs lost. In Kentucky and Indiana, 45,000 and 55,000 jobs are projected be lost, respectively.